Keene State College | Residential Life

RESIDENTIAL LIFE

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Employment

Off Campus Housing

Residence Hall & Dining Application

NEED HELP?
– additional instructions
OTHER OPTIONS
applications for other students

Complete this form ONLY if you are:

RETURNING – a current student returning from a study away or exchange program
READMITTED – a readmitted student
OFF CAMPUS – a current student wanting to move on campus
LEAVE OF ABSENCE – a student returning from a leave of absence

All fields marked with an * are required.

Student Information

Student ID Number
This number appears in your acceptance letter - DO NOT use your Social Security #

(Example: 0123456)

First Name

Middle Name

Last Name

Home Information

City

State/Province

E-mail Address
Your current e-mail address is required if you want to receive an e-mail confirmation
Example: astudent@ksc.mailcruiser.com

Residence Hall Contract Information

Student Status

Contract begins

Residence Hall Preferences

More information

1st

My first hall preference:

2nd

My second hall preference:

Roommate Preferences

1st

Roommate – First preference (must be mutual)

First Name

Middle Name

Last Name

2nd

Roommate – Second preference (must be mutual)

First Name

Middle Name

Last Name

Dining Contract Information

All resident students must enroll in at least a 12-meal plan (unless they reside in Bushnell, Tisdale or Pondside II apartments). The dining contract is for the entire academic year and may not be decreased or cancelled while the student resides on campus.
Dining information

Select a Meal Plan:
19 meals – Traditional
19 meals – Traditional + FLEX
12 meals – Traditional
12 meals – Traditional + FLEX
5 meals – Traditional
5 meals – Traditional + FLEX

Contract

Contract Terms:
By submitting this application:

I consent to the Terms and Conditions of the Residence Hall Contract.
I understand that this contract is for both semesters, excluding all announced vacation periods.
I agree to the announced rates and have read and accept the terms and conditions of the contract.
This contract is binding for the entire academic year.
On-campus residents will not be released from this contract unless they no longer attend Keene State College.

Terms and Conditions of the Residence Hall Contract.

Housing and Dining Contract Consent

I am 18 years old or older and I consent to the terms of the Residence Hall Contract.

This student is under 18 years old. As the parent or guardian identified below, I consent to the terms of the Residence Hall Contract.

Parent/Guardian First Name

Parent/Guardian Middle Name

Parent/Guardian Last Name


Updated: February 1, 2011
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