MUSCATINE COMMUNITY COLLEGE APARTMENT APPLICATION   Name: __________________________________________ SS#: ___________________________________________ Permanent address: ______________________________ City: ___________________________________________ State: ______________   Zip: _______________________ Telephone: (      )_________________________________ Cell Phone: (      )_________________________________ Date of birth: ___________________   Age: ___________ Applied for admission to MCC:   (   ) Yes   (   ) No   Email address: __________________________________ Contact in case of emergency Name: ___________________ Address: _________________ City: _____________________ State: ______   Zip: ________ Telephone: (     )___________ Alt. Tel: __________________ Relationship: _____________ Starting term: _____________ (Semester/yr)   Check one:   Check one:     (   ) Male   (   ) New     (   ) Female   (   ) Returning   Major: _______________________   Contract length:    (   ) 9-month     (   ) 12-month     (   ) Summer     (   ) Fall Only     (   ) Spring Only   I would be interested in learning about a resident assistant position:   (   ) Yes   ROOMMATE PREFERENCES: Names First Choice: ___________________________     Phone: ________________ Second Choice: ________________________     Phone: ________________ Third Choice: __________________________     Phone: ________________   ROOMMATE PREFERENCES: (Indicate any specific individual or general requests such as geographical area, major, age, habits, housekeeping, lifestyle, etc.) __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________   Have you ever been convicted of a felony?   (   ) No   (   ) Yes   I understand that the preferences indicated above are not binding upon Muscatine Community College. I agree to accept a room and roommate assigned by the College.   I understand the room contract (the "Contract") is binding beginning at the term indicated above. I agree to pay for such at the rate set forth in the Contract and in the manner set forth by Muscatine Community College.   I agree to abide by all rules and regulations outlined in the CONTRACT and on this application. I have read and understand the provisions. I hereby apply for an apartment and have enclosed the $150.00 security deposit (to be credited against sums owing under the Contract) to serve as a reservation. I understand that termination of this contract will result in the loss of the $150 deposit.   _______________________________     ________________ Signature of Applicant     Date   _______________________________     ________________ Signature of Parent or Guardian     Date (for applicants under 18 yrs. Old)