Housing Application

Check the semester that you are applying for *

Fall 2024 Spring 2025 Summer 2025 Fall 2025

Last Name *

First Name *

Middle Name

Birth Date *

Street/P.O. Box *

City, State, Zip *

Preferred Name

Student ID

Cell Phone Number *

Home Phone Number *

Email (CWC Email Preferred) *

EMERGENCY CONTACT

Emergency Notification, check one *

Parent Guardian Next of Kin Other

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Address *

SEX/GENDER IDENTIFICATION

Check a Box

Female Male

Sex/Gender Identification Other/ Self Identify

GENERAL QUESTIONS

Have you ever been convicted of a felony? *

Yes No

If yes, please list the date(s), type of offense, and jurisdiction where the offense(s) was committed:

Do you have a documented disability that you have (or will be) requesting reasonable accommodations for?

Yes No

Allergies/medical concerns you would like us to be aware of?

GETTING TO KNOW YOU

Have you ever lived in CWC housing before?

Yes No

Class Standing

Program Major/Degree

Building Preference (Please note: Freshman are required to stay in Mote Hall or Residence Hall, except for Athletes and Outdoor Education students.) *

Secondary Building Preference (if primary preference is not available)

Roommate preference (if any)

Please list any athletic teams that you plan to be a part of

In one word, how would you describe your personality?

What is your favorite candy bar?

Political Leanings? Check one:

Conservative Liberal Moderate

What time do you prefer to go to bed?

Early (before 11pm) Late (after 11pm)

What time do you prefer to study?

Afternoons Evenings and Nights Mornings

Are you a smoker?

Yes No

Would you object to living with a smoker?

Yes No

Are you in the Outdoor Education and Leadership, Expedition Science, or Outdoor Recreation and Tourism programs?

Yes No

Would you prefer single occupancy (Private room)? ***Reminder, single occupancy cost more than double occupancy and single occupancy is offered last if space is available. No students are guaranteed single occupancy.

Yes No

What Meal Plan do you prefer? (Meal Plan rates are listed on the housing portion of the website)"

Meal Plan A Meal Plan B Meal Plan C (Only available for East and West Apartments) ASI (No meal plan available)

TERMS AND AGREEMENTS

After submitting this application, you must pay a $100 Housing Deposit to secure a housing reservation. No housing reservation will be made until the Housing application is completed, and the $100 housing deposit has been paid to the Business Office. You, as the student are responsible for knowing the terms and Conditions for Occupancy at Central Wyoming College at the time of check-in. You can find the housing contract which outlines these terms and conditions at this link: 0q.41javhkn.com/housing.

Please read the contract in its entirety before finalizing your housing application.

CERTIFICATION OF AGREEMENT / UNDER AGED SIGN-OFF

For students under the age of 18 at the time of application, Central Wyoming College requires the signature of the parent or guardian indicating consent to the Housing Application-Agreement.

Date

Digital Student Signature

Digital Parent Signature

Locations

Information For

EMERGENCY CONTACT

SEX/GENDER IDENTIFICATION

GENERAL QUESTIONS

GETTING TO KNOW YOU

TERMS AND AGREEMENTS

CERTIFICATION OF AGREEMENT / UNDER AGED SIGN-OFF

Ready to make it happen?

Riverton

Lander

Jackson

Dubois