Residence Hall
Application/Contract

Complete this form to apply for On-Campus residency.
Note that when you click the "Submit" button below, you will then have to print a "Signature" page and mail it along with a refundable $100.00 reservation and damage deposit. Your application will not be complete until the Signature Page and Deposit are received in the office of the Housing Director. Make checks, M.O.'s payable to: Meridian Community College
First Name:                 MI:        Last Name:
 
   
Social Security Number:
  -      -   
 
Address:
City:
   
State:                      Zip/Postal Code:
   -   
 
Country (Int'l. Students Only)
E-Mail Address:
If you will require special accommodations, please contact the Housing Director at 601-484-8894 or 1-800-MCC-THE-1
 
CURRENT Phone:
Area Code:   Prefix:   Last 4 digits:
Country Code (Int'l. Students Only):
 
 

Your Gender:
Female     Male

Age (We really need this.):
Your Program of Study or Major:
 
Your Classification (Click One):
Fr.  Sop.   Other
       Term(s) for which you are applying:


Requested Roommate (Type a name):
(Roommate preferences will be honored if both applicants request each other.)
 
Residence Hall Preference:


When you are sure you have entered all items correctly, click the "Submit" button. - OR -
Click the "Clear Entries" button to remove all entries you've made in the blanks and start over.


           

Meridian Community College does not discriminate on the basis of race, color, national origin, sex, disability, religion, or age in admission or access to or treatment or employment in its programs and activities. Compliance with Section 504 and Title IX is coordinated by Quinn Carlisle, Director of Student Services, 910 Hwy. 19 North, Meridian, MS 39307. 1-601-484-8622; fax: 1-601-484-8607, email: qcarlisl@mcc.cc.ms.us