Revised 4/14/20 1 | Page
OFFICE OF STUDENT HOUSING & RESIDENTIAL LIFE
APPLICATION 2020-2021 ACADEMIC YEAR
Application Deadline: May 1st, at 6:30 pm email email@example.com
Recommendations Deadline: On or Before, May 15
at 6:30pm Emailed by Recommender ONLY.
Electronic copies of the recommendation forms( pages 6-8) are available on the school website for download.
Please complete this form entirely, submit Application and Recommendation forms by email: firstname.lastname@example.org.
Please fill out all portions of the application. If a question is not applicable please indicate the section with a
Any incomplete attachments or applications will not be processed. Any applications received after the
APPLICATION DEADLINE will not be considered. DO NOT TURN IN YOUR APPLICATION TO LODGE
STAFF OR OFFICE.
I. Personal Information:
First Name Last Name
Permanent Home Address City, State, Zip Code
Permanent Home Address (Line 2 if needed) Home Phone Number
________-__________-__________ ☐ YES ☐ NO
Cell Phone Number Can you receive Text? Primary Email Address
College of the Siskiyous Student Email Current Building / Room Number
(If living in lodges)
II. Academic Information:
_____________________ ☐ YES ☐ NO _____________________________________
First Semester at COS Transferred to COS If marked YES, which institution(s)
(Fall 2020, Spring 2020 etc.)
Objective at COS (Check all that apply)
___________________________________ ☐ Transfer ☐ Certificate Program ☐ A.A. Degree
Current Major/Field of Study
_________ _________ _____________________
Units Planned for Enrollment Total Units Currently Expected Graduation
Fall 2020 Semester Completed Date
Last Semester GPA Cumulative GPA