Name:___________________________________________________________________________________________________
Last Name First Name Middle Name
Mailing Address: ___________________________________________________________________________________________
City: ___________________________________________ State: _________ Zip:______________ SMCC ID: _________________
Date of Birth: ____________________ Email Address: ________________________________________________________
Home Phone Number: ________________________________Cell Phone Number: _____________________________________
Classicaon: Freshman (0-23 Hours) _______ Sophomore (24+ Hours) _________Gender: Male___________ Female_________
I am applying for : Fall _______________ Spring ______________ Current GPA: _________________ ACT: ______________
August January
Residence Hall Applicaon Fee $150.00
Please indicate your Residence Hall preferences (1st, 2nd, 3rd)
Women Men
____ Women’s 1 ___Men’s 1
___ Men's 2
___ Alford-Conerly
Roommate Preferences
Do you have a preferred roommate? Please list their name: _________________________________________________________
Do you have a preferred suitemate? Please list their names: ________________________________________________________
Which is more important? Roommate choice: ______ Residence Hall Preference: ______
I give my permission for SMCC to release my name and contact informaon to my prospecve roommate that I am assigned.
Yes ________ No _________
Do you have an athlec or acvies scholarship to aend SMCC: Yes______ No______
Please list the sport or acvity:_________________________________________________________________________________
Housing applicaons are processed according to the date the applicaon and the fees are received. Fees do not guarantee a room.
Roommate preferences must be mutually agreeable and indicated on both housing applicaons. Roommate preferences cannot
be guaranteed. You are encouraged to submit both applicaons at the same me.
Students that decide not to stay in the residence hall should send a wrien request before the 2nd Friday in July to receive a full
refund of their housing applicaon fee. Aer this date, we cannot promise a full applicaon fee refund.
I acknowledge that I have read and understand the condions contained in this housing applicaon and agree to be bound by its terms.
Student’s Signature: ____________________________________________________________________________ Date: _________________
If student is under 18, signature of parent or guardian: _________________________________________________Date: _________________
For Housing Oce Only:
Receipt No.________________
Date: _____________________
Hall:______________________
Residence Hall Housing Applicaon
Southwest Mississippi Community College does not discriminate on the basis of race, color, national origin, age, sex, religion, or disability in its programs, activities or em-
ployment practices. The following persons have been designated to handle inquiries and grievances regarding the non-discrimination policies: Mrs. Rhonda Gibson, Director
of Disability Support Services, 601-276-3885; Dr. Brent Gregory, Vice President for Student Affairs and Title IX Coordinator, 601-276-3717; SMCC, 1156 College Drive,
Summit, MS 39666.
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signature
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Important Housing Informaon– All fees are subject to change
Applicaon Fee
In order to reserve a residence hall room at SMCC, a student must complete the housing applicaon and return it to student ser-
vices with the applicaon fee. The applicaon fee is $150.00 for each residence hall. In order to reserve a room students must
submit the applicaon and $150 fee. Students that decide not to stay in the residence hall should send a wrien request before
the 2nd Friday in July to receive a full refund of their applicaon fee. Aer this date, we cannot promise a full applicaon fee re-
fund.
Residence Hall students must be enrolled in 12 tradional, on campus hours to live in the residence halls. Online classes are not
counted as part of the12 hours. Schedules will be checked during the rst week of school.
Students must have a 1.5 GPA to be eligible for campus housing. Grades are checked before moving into the residence hall and
they are checked between semesters. The failure to maintain a 1.5 overall GPA would result in dismissal from the residence halls.
Students are required to purchase a meal plan if they are living in the residence halls. Five day meal plans are automacally
charged to the students account once they have turned in their housing applicaon and fee. If the student would like to receive
the seven day meal plan, the student should come to student services to make the changes. All meal plan changes should be made
within the rst two weeks of the semester.
Conrmaon of room status will come from the Housing Department. Students will be allowed to move into the residence hall
before classes begin. A leer will be sent to the student about move in mes and it will be listed on the website. A student’s hous-
ing applicaon may be forfeited if the student is not completely moved into the assigned room by the rst day of classes.
Students are expected to occupy their rooms unl the end of the academic semester in which they are enrolled. Should a student
decide to move out of the residence hall during the semester the room rent is not refunded. The meal plan is only refunded or
parally refunded if the student moves out during the rst four weeks of school. If the student moves out of the residence hall
during the rst week of school 100 percent of the meal plan is refunded, the second week, 75 percent; the third week, 50 percent;
and the fourth week 25 percent. Aer the fourth week, no refund on the meal plan will be made. This process is listed on page 43
of the SMCC student handbook. The room deposit is refunded if the student properly checks out and the student has no holds in
the business oce.
Students must be at least 18 years of age to live on campus, unless given special permission by the Vice-President for Student
Aairs. Request for special permission can be emailed to the Director of Student Acvies & Housing at agray@smcc.edu.
Residence Hall students are expected to follow the rules and regulaons found in the SMCC Student Handbook. If a student fails
to follow these rules or college policy, the college reserves the right to revoke housing privileges.
Southwest Mississippi Community College Tuion and Fees can be found at www.smcc.edu / Quick Links/ Tuion and Fees
housing@smcc.edu
(601)276-3732
Fax (601)276-3896
Mail Applicaon/ Payment to:
Director of Student Acvies & Housing
Southwest Mississippi Community College
1156 College Drive
Summit, MS 39666
Southwest Mississippi Community College does not discriminate on the basis of race, color, national origin, age, sex, religion, or disability in its programs, activities or em-
ployment practices. The following persons have been designated to handle inquiries and grievances regarding the non-discrimination policies: Mrs. Rhonda Gibson, Director
of Disability Support Services, 601-276-3885; Dr. Brent Gregory, Vice President for Student Affairs and Title IX Coordinator, 601-276-3717; SMCC, 1156 College Drive,
Summit, MS 39666.