One College Drive
Calais, ME 04619
Residential Life 207-454-1054
: Washington County Community College is an equal opportunity/affirmative action institution and employer.
For more information; please call Tatiana Osmond, Affirmative Action Officer, at 454-1094.
AD – Form Housing Application; Revised: July 8, 2019; amd
On-Campus Housing Application
Last Name: ___________________________________ First Name: __________________________________ M.I.: _____________
Mailing Address: _______________________________________ City: ______________________ State: _________ Zip: ________
Phone Number: ___________________________________ Mobile Phone Number: ________________________________________
Cell phone carrier: US Cellular Verizon AT & T Tracfone Other __________ Text Updates: ___Yes ___No
Email address: ______________________________________________________ Program of Study: _________________________
Emergency Contact: ___________________________________________________ Phone Number: __________________________
Family Physician: _____________________________________________________ Phone Number: _________________________
First-year student _ Second-year student Semester/Year: Fall Spring 20 _____ Male _ Female _ Age _____
PREFERENCE (S): The Residential Life staff at Washington County Community College will be working to make your stay as
comfortable as possible. Please take a few minutes to answer the following questions to help us assign roommates and arrange
residential life programs for you. Remember, if you desire a specific person as a roommate, you both must request each other on your
1. Do you smoke? (WCCC is tobacco free) Y N
2. Would you prefer a non-smoking roommate? Y N
3. Do you study with the stereo on?
Are you a “night” person? Y N
Do you have a specific person (s) you would like to
room with? Doesn’t matter _______ If so, please list:
6. Do you plan to:
Go home on most weekends?
Stay on campus most weekends?
Go home only on long weekends?
7. Are there any medical problems or specific diet concerns
of which the staff should be aware? LIST:
8. Have you ever been convicted or adjudicated of a crime
other than a traffic violation? (If so, please describe
9. Which characteristics best describe your personality?
sometimes quiet, but sometimes outgoing
outgoing; interested in nearly everything
10. Is there a medical or personal reason that you feel you
need a single room? Y N If yes, please explain.
The primary objective of the Residential Life staff is to provide an atmosphere conducive to study, relaxation and growth. Therefore,
all residents are asked to follow guidelines set forth in the Student Handbook and Housing Contract. Residents are strongly
encouraged to become familiar with the policies and procedures.
Return this completed application with a $150 room reservation deposit to the Student Accounts Office. Make your check or money
order payable to Washington County Community College. For credit card use, contact Heather Smale, 207-454-1025.
Washington County Community College is Alcohol and Drug Free
Student Signature: _______________________________________________________________________Date:________________
For Business Office Use Only
Date Received: _____________ Receipt #:____________ Received By:_____________
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