Housing Application

First Name:
Middle Name:
Last Name:
Gender:
Male Female
Mailing Address Line 1:
Mailing Address Line 2:
City:
State:
Zip Code:
Date of Birth MM/DD/YYYY:
Contact Telephone #:
Choose one:
Home Cell
Email:
Father's Name:
Mother's Name:
Name of Last High School Attended:
City/ State:
Graduation Year:
Other Colleges Attended:
Classification:
Freshman Sophomore
Junior Senior
Intended Major:
Private Rooms: Please refer to the Tuition and Fees listing on the Website for Private Room Fee information.
Female Students:
Stevens Residence Hall Whitfield Residence Hall
Room Preference:
Private Room Non-private Room
Male Students in Cockroft Room Preference:
Private Room Non-private Room
Roommate Preference:
In what school activities have you participated?:
Denominational or Church Preference:
In what church activities have you participated?:
List Hobbies and Personal Interests:
A DAMAGE DEPOSIT OF $50 MUST BE PAID BEFORE ROOM ASSIGNMENT CAN BE MADE. The deposit is refundable through June 30th. Send deposit to: Blue Mountain College, Office of Admissions, P.O. Box 160, Blue Mountain, MS 38610.
Due to an increased demand and limited space for on campus housing, housing at Blue Mountain College is available on a first-come, first-served basis. The Office of Student Services assigns housing. To be considered for housing for the fall semester, a student should submit all the required forms by May 1. The goal for finalizing fall semester housing assignments is July 1. To be considered for housing for the spring semester, a student should submit all the required forms by December 1. The goal for finalizing spring semester housing assignments is January 6. Students will be contacted by the Office of Student Services when a housing assignment has been made. If a room becomes available and a student is on a waiting list for housing, housing assignments may be made at any time during the semester.
I have read and understand that a $50 deposit must be paid before I am assigned to a room:
Agree
I authorize the Office of Student Services to release my information to my assigned roommate/suitemate(s):
Agree
BY COMPLETING THIS FORM I AM INDICATING MY INTENT TO ELECTRONICALLY SIGN THIS WAIVER AND WARRANT THAT ALL OF THE INFORMATION I HAVE PROVIDED IS TRUE, COMPLETE, AND ACCURATE.:
Agree
Verify:
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