NAME: ____________________________________________ BAY COLLEGE ID #: _____________________
AGE: _____________ DATE OF BIRTH: __________________ MALE FEMALE
YEAR OF HIGH SCHOOL GRADUATION: ___________________ SELF‐IDENTIFY ____________________
HOME PHONE: ___________________________________ CELL PHONE: ____________________________
Do you prefer to:
□ Keep your room neat with everything in its place most of the me?
□ Not worry about how your room looks, leng it get cluered somemes or even most of the me?
Do you prefer to go to bed:
□ Relavely early (generally before midnight)?
□ Late (generally aer midnight)?
When you are studying, are you:
□ Easily distracted, preferring relave quiet?
□ Able to ignore background noise?
Do you expect your apartment to be:
□ A fairly private place to relax and study?
□ A place where your friends come to socialize a bit?
How do you feel about having your roommate use/borrow your things?
□ I don’t care
□ It’s okay as long as he/she asks.
□ My roommate should never use my things
How do you feel about your roommate having students of the opposite sex in
your apartment?
□ I don’t care
□ I would prefer not
EMERGENCYCONTACTINFORMATION:
Name: __________________________________________________________________ Home Phone: ___ _______________
Cell Phone: _________________________________ Relaonship: ___________________________________________
I represent that each answer is truthful and constutes a full and complete disclosure of my knowledge with respect to the
quesons and hereby authorize a criminal background check as may be necessary in reaching a decision regarding acceptance of
this housing applicaon. I understand that any misrepresentaon of facts shall constute cause for removal from student
housing, regardless of when discovered by the College. I understand that Bay College’s acceptance of this applicaon for student
housing accommodaons will ensure that I will be considered for a student apartment, but does not guarantee me the
apartment/roommate preferences I have indicated.
Signature: __________________________________________ Date: __________________________
Student Housing is
completely alcohol/
tobacco/marijuana free,
regardless of resident(s) or
guest(s) age.
COLLEGEPOLICY
Office Use Only
Security Deposit received?
Date_________ By__________
Background Check completed
Date_________ By__________
MISSINGPERSONCONTACTINFORMATION(IfdifferentthanEmergencyContactInformaon):
Name: __________________________________________________________________ Home Phone: ___ _______________
Cell Phone: _________________________________ Relaonship: ___________________________________________
