Housing Reservation Form

 

Return to Housing Information Page

Please fill out this form and submit it to the Trinidad State Housing Department

 

Please enter information in all of the fields so that we can do our best to make your experience at the TSJC Housing Center the best it possibly can be.

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Enter Full Name -

First:

Middle:

Last:

General Information:
Student ID#:
Home Phone:
Cell Phone (student):
Email Address:
Confirm Email Address:
Intended Plan of Study:
Date of Birth
Gender	Male         Female
Parent/Guardian:
Scholarship Athlete:	Yes         No
if yes, which sport?	Choose One Baseball Basketball-Men's Basketball-Women's Golf Softball Volleyball
Home Address:
Street:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
PLEASE NOTE: PLEASE READ THE RESIDENCE HALL TERMS & CONDITIONS LOCATED IN THE RESIDENCE HALL HANDBOOK

Personal Data for Room and Hall Assignment
1. Do you want a Roommate?	Yes         No
if yes, Preferred Roommate Name?
2. Prefer Roommate from:	Choose One Rural City
3. Your Study Habits:	Choose One Minimum Average Above Average
4. Music Preference:	Choose One Country/Western Rock Classical Rap Other
5. Do you go to bed...	Choose One Early Late
6. Do you consider yourself...	Choose One Tidy Average Untidy
7. Hobbies, interests, etc.
8. Are you a smoker?	Yes         No
Do you mind if your roommate is a smoker?	Yes         No
	(residence halls are smoke-free)
9. Please indicate any physical, medical, or special needs that should be considered in making hall/room assignment or should be known in case of emergency:
Note: All residence hall students must submit certificate of immunization

Required Information:
(You MUST answer this question)
Have you ever been convicted of a crime? (traffic violations are exempt).	Choose One Yes No
If you answer “YES”, please attach a statement of explanation. Trinidad State Junior College reserves the right to deny or place conditions on admission to its residence halls to students whose criminal record may indicate danger to the health, safety or welfare to members of the Residence Hall community.

Meal Plans and Length of Contract
All residents are required to select a meal plan listed:	Choose One 15 meals per week 19 meals per week (freshman required)
All resident hall contracts are for an academic year. Indicate the term you are starting:	Choose One Fall Spring Summer
The above information is for hall/room assignment and does not commit you or Trinidad State Junior College to each other. The completion of the above information is required prior to hall/room assignment