Common use of Please Print Clause in Contracts

Please Print. Name E-mail FIRST MI LAST ❏ Male ❏ Female Date of Birth Home Phone ( ) Cell ( ) Home Address STREET APT. # CITY STATE ZIP [ ] Mark here if you have any chronic ailment, handicap, disability or medical reason which would require special accommodations. Please list special accommodations required *The above information is needed by the college in order to reasonably accommodate students covered by Section 504. Please indicate your preference: Private Room – cost of a private room is twice the cost of a double room. Double Room (please indicate the name of any preferred roommate below) Preferred Roommate name: Choose your preference: [ ] Prefer same sex wing of unit [ ] Would not object to co-xx xxxx of unit The college does not guarantee assignments or single room requests. Families/married couples may not apply to live together in a room in the housing unit. Room assignments are based on the order in which the agreements are received. They are not based on race, gender identity, gender expression, sex, sexual orientation, religion, color, national origin, age disability, or status as a protected veteran. Students must present evidence of having immunization for Meningococcal disease (Meningitis) or a statement of exemption on file with the college. You must submit the Immunization Record prior to moving on campus Meal Plans: Resident students are required to purchase the 14 meal plan. Meal plan charges for all students living on campus will be added to the student’s account. For more information regarding the meal plan, please contact the Financial Services Coordinator at 000-000-0000. My signature below acknowledges that I understand the terms of this agreement and verify that I have read the rules and regulations governing student housing. Student’s Signature Date Parent/Guardian’s Signature Date (Required if Student is a minor under the age of 18 years) White – State Tech Yellow – Student

Please Print. Name E-mail FIRST MI LAST ❏ ❑ Male ❏ ❑ Female Date of Birth Home Phone ( ) Cell ( ) Home Address STREET APT. # CITY STATE ZIP [ ] Mark here if you have any chronic ailment, handicap, disability or medical reason which would require special accommodations. Please list special accommodations required *The above information is needed by the college in order to reasonably accommodate students covered by Section 504. Please indicate your preference: Private Room – cost of a private room is twice the cost of a double room. Double Room (please indicate the name of any preferred roommate below) Preferred Roommate name: Choose your preference: [ ] Prefer same sex wing of unit [ ] Would not object to co-xx xxxx of unit The college does not guarantee assignments or single room requests. Families/married couples may not apply to live together in a room in the housing unit. Room assignments are based on the order in which the agreements are received. They are not based on race, gender identity, gender expression, sex, sexual orientation, religion, color, national origin, age disability, or status as a protected veteran. Students must present evidence of having immunization for Meningococcal disease (Meningitis) or a statement of exemption on file with the college. You must submit the Immunization Record prior to moving on campus Meal Plans: Resident students are required to purchase the 14 meal plan. Meal plan charges for all students living on campus will be added to the student’s account. For more information regarding the meal plan, please contact the Financial Services Coordinator at 000-000-0000. My signature below acknowledges that I understand the terms of this agreement and verify that I have read the rules and regulations governing student housing. Student’s Signature Date Parent/Guardian’s Signature Date (Required if Student is a minor under the age of 18 years) White – State Tech Yellow – Student

Please Print. Name E-mail FIRST MI LAST ❏ q Male ❏ q Female Date of Birth Home Phone ( ) Cell ( ) Home Address STREET APT. # CITY STATE ZIP [ ] Mark here if you have any chronic ailment, handicap, disability or medical reason which would require special accommodations. Please list special accommodations required *The above information is needed by the college in order to reasonably accommodate students covered by Section 504. Please indicate your preference: Private Room – cost of a private room is twice the cost of a double room. Double Room (please indicate the name of any preferred roommate below) Preferred Roommate name: Choose your preference: [ ] Prefer same sex wing of unit [ ] Would not object to co-xx xxxx of unit The college does not guarantee assignments or single room requests. Families/married couples may not apply to live together in a room in the housing unit. Room assignments are based on the order in which the agreements are received. They are not based on race, gender identity, gender expression, sex, sexual orientation, religion, color, national origin, age disability, or status as a protected veteran. Students must present evidence of having immunization for Meningococcal disease (Meningitis) or a statement of exemption on file with the college. You must submit the Immunization Record prior to moving on campus Meal Plans: Resident students are required to purchase the 14 meal plan. Meal plan charges for all students living on campus will be added to the student’s account. For more information regarding the meal plan, please contact the Financial Services Coordinator at 000-000-0000. My signature below acknowledges that I understand the terms of this agreement and verify that I have read the rules and regulations governing student housing. Student’s Signature Date Parent/Guardian’s Signature Date (Required if Student is a minor under the age of 18 years) White – State Tech Yellow – Student