Student Housing Application Please complete and submit the housing application below to apply for on-campus housing at SWCC. Contact Information Permanent address outside the United States? Yes No First Name* Last Name* Email* Permanent Address* City* State* Select one Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip* Address information* Phone (xxx-xxx-xxxx)* Date of Birth (MM/DD/YYYY)* Sex at Birth* Select One... Male Female Prefer not to disclose Gender Identity Select One... Male Female Transgender Male Transgender Female Non-Binary Not Disclosed Legal Sex Select One... Male Female Transgender Male Transgender Female Non-Binary Not Disclosed Pronouns Select One... She/Her/Hers He/Him/His They/Them/Theirs These pronouns do not apply to me Prefer not to answer Preferred Name Status Participating in a varsity sport?* None Baseball Men's Basketball Women's Basketball Bass Fishing Men's Cross Country Women's Cross Country Dance Men's Golf Women's Golf Softball Sports Shooting Men's Track & Field Women's Track & Field Volleyball Select your application status* Select... New Application ($150 deposit required with this application) Renewal (Previous deposit of $150 will be retained) Cancelations must be made before July 1 for full deposit refund. A nine-month lease is required during fall entrance. The total semester is payable at the beginning of each term. Semester* Choose one... Fall 2023 Spring 2024 Fall 2024 Spring 2025 Room Preference* Choose one... West Hall - Men's Dorm Apartment-style $3,305 West Hall per semester* $3,830 Apartment-style per semester* *Prices include room accommodations and $925 per semester on your SWCC dining card. Additional meal plan options will be available when you complete your housing contract. Prices effective July 1, 2022. Payment Option Your deposit must be paid to secure your placement on the housing list. Method of payment for housing deposit:* Select one... Online - Credit/Debit By Phone - Credit/Debit In person - Cash/Check/Credit/Debit By Mail - Check After the form is submitted, you will be redirected to complete your online payment. Due to system requirements, payments must be made from within the U.S. Please call the SWCC Business office during normal business hours at 800.247.4023, ext. 448, or 641.782.1448. SWCC accepts American Express, Discover, MasterCard, and Visa. Payments can be made at the SWCC Business Office during normal business hours. SWCC accepts American Express, Discover, MasterCard, and Visa. SWCC Business Office1501 W. Townline StreetCreston, IA 50801 Make checks payable to: Southwestern Community CollegeBusiness Office1501 W. Townline StreetCreston, IA 50801 Enrollment Classification Enrollment Classification* Arts & Sciences (College Transfer Program) Career and Technical Education Program Probable Major/Program Select... Undecided Accounting Accounting & Information Technology Administrative Office Technology Art Arts and Sciences Transfer Program Agriculture Auto Collision Repair Automotive Repair Business Administration Business General Carpentry Child Development Computer Science Education Electrical Technology Graphic Design Industrial Technology Information Technology Systems Networking Management Info Systems Math Music - Instrumental Music - Vocal Nursing Office Skills Physical Education Physical Science Psychology Science Related Web Development Welding Other Other Information For roommate matching, list your likes Dislikes Interests and activities Roommate preference (list name/s) Physical limitations/disabilities* Yes No Have you received the meningitis info brochure?* Yes No Please review the Meningitis Information page on our website. Have you had the meningitis vaccination?* Yes No Will you be requesting accommodations for an emotional support animal? Yes No Are you willing to live with a roommate who has an emotional support animal? Yes No I would consider it depending on the type of animal Type your initials as your digital signature.* It is the policy of Southwestern Community College not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status. If you have questions or complaints related to compliance with this policy, please contact: Equity/Title IX Coordinator, Southwestern Community College (Administration Center), 1501 W. Townline St., Creston, IA 50801; phone, 641.782.1456; or email, TitleIXCoordinator@swcciowa.edu, or the Director of the Office for Civil Rights, U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204; phone, 312.730.1560; fax, 312.730.1576; TDD, 800.877.8339; or email, OCR.Chicago@ed.gov. Data Consent* I agree that by submitting this form/application to Southwestern Community College, I give consent to Southwestern to store and use personal and academic-related information for all recruitment and academic records-related activities. I also agree to allow Southwestern to use multiple forms of communication for the purpose of recruitment and academic-related information during my academic career. I understand that if I do not agree to this statement, this form/application cannot be submitted. Submit Thank you! Your student housing application has been submitted. Thank you for choosing SWCC. Please turn on javascript to submit your data. Thank you!
