RUST RESIDENCE COLLEGE HOUSING …

1 rust RESIDENCE . COLLEGE HOUSING APPLICATION education . PERSONAL INFORMATION _____. MALE FEMALE rust COLLEGE #. _____. Last Name First Middle Street Address _____. City _____ State _____ Zip _____. Phone Number _____(Home) _____(Cell). Social Security # _____ Date of Birth _____. EMERGENCY CONTACT. _____ _____. Parent or Guardian's Name Relationship to Applicant Address _____ City_____ State ____ Zip_____. Telephone ( )_____. PREFERENCES. Requests will be honored, if possible RESIDENCE Hall: Emma Elzy Wiff Davage-Smith rust (First-time Freshman only) Gross (First-time Freshman only).

2 Roommate: 1st _____ 2nd _____. 3rd _____ 4th _____. Do you have any physical disabilities or conditions warranting special consideration in making your room assignment? Yes No If yes, a statement from your physician must be attached. CLASSIFICATION: Freshman Sophomore Junior Senior Amount Enclosed $_____ Payment Confirmation #: _____. All residential students are required to pay a $ room reservation fee annually to reserve a space in campus HOUSING . This fee must be paid to guarantee campus HOUSING . Campus HOUSING is competitive.

3 Return form and deposit to the Dean of Students' Office, rust COLLEGE , 150 rust Avenue, Holly Springs, MS 38635, ext. 4077. You may also pay this fee online at rust COLLEGE 's property insurance is not designed to cover the personal effects of students ( stereo and computer equipment, clothes, and other personal items). It is important that students understand that the purchase of property insurance for personal items is their responsibility. We recommend that you contact National Student Services, Inc. for information on student's personal effects property insurance.

4 NSSI offers affordable personal property coverage for purchase by students and will be pleased to provide coverage. They may be reached at 1-800-252-6774. or you may apply online at RESIDENCE Halls are closed during all breaks unless otherwise noted. Student Signature_____ Date_____. FOR OFFICE USE ONLY: Date Received_____ Signature_____. Amount Received_____ RESIDENCE Hall: Male_____ Female_____. Director of Housing_____ Date_____. ALS2011.