Housing Application

To apply to Mesa State Housing, complete the application and $150 deposit/application fee. $25 is a nonrefundable application fee. For those wanting specific, mutual roommates, please apply together, identifying the student's name. Assignments are made based on date of receipt of the completed housing application, required deposit and the application fee, and the Student Housing and Dining Contract. Every effort will be made to accommodate your request. You do not have to be accepted to Mesa State to apply for housing, but it is important to complete your application for undergraduate admission in a timely fashion.

Note:  required fields are in bold.

Bill To: (This information must match the Credit Card used).
Full Name :
Address1:
Address2:
City, State, Zip:
Phone:
Fax:
Email:
Student Information: Same As Billing
Student ID:
Full Student Name: Date of Birth
Mailing Address1:
Mailing Address2:
City, State, Zip:
Phone: Cell Phone
Student Email:
Fax:
Preference Information:  
Application For:
Term::
Gender : 
Student Status: 


Rank In Order of Preference: (Please note: Beginning in Fall 2007 Pinon Hall is all male and Rait Hall is all female.)
Hall Preference :(Please number in order of preference and include at least two preferences)
 1.
2.
3.
4. 		 

Room Preference:
(Please number in order of preference and include at least two preferences)

1.

2.

3. 		 

(Please Note: Single rooms cost more)
Meal Plan :
Meal Plan Information
If No choice is made you will be assigned and billed for Plan A.
MAVmoney
Meal Plans include $175 in MAVmoney per semester.

Lifestyle Questions
Do you smoke? Yes No (All Halls and Apartments are non smoking facilities)
Do you consider yourself tobacco-free? Yes No
In what type of study environment do you work best? Quiet environment Background noise
Where do you normally study? Room Library Other
What time of day do you prefer to study? AM PM Other
What temperature do you usually keep your room? Warmer Cooler
What types of music do you prefer? Alternative Classical Country Easy listening Hip Hop/Dance Jazz Metal Rap Rock R&B Christian

Do you require a handicap accessible room? Yes No
Accommodation of Physical/Medical Conditions
To be considered for physical or medical accommodations, prior notification is necessary to evaluate and accommodate your individual needs. Please enclose a written statement describing your condition as well as what types of accommodations need to be made. Include supporting medical documentation. Students requiring design/paid singles will be assessed an additional charge according to the College rate schedule.

Do you prefer an intensive study room? (Rait and Monument Halls Only) Yes No
How tidy are you? Very Moderately " Lived in Look"
How do you expect your room to be kept? Very neat Fairly neat Messy
Do you consider yourself primarily: an Early Riser a Late Night person
Are you taller than 6' and would like to request an extra-long mattress? Yes No
Please list hobbies or interests:
Please list any activities you're involved with at Mesa State:

Roommate Request
(optional)

Roommate Preferences:

List the name(s) and student ID of your preferred roommate(s). Be sure to accurately spell their names; do not use nicknames. Preferences will be honored in a space availability basis. However, requests must be mutual and received by May 1st to be considered. Both contracts should be returned to Housing & Residence life as close to the same date as possible.

 
Important: You must answer the following question for your application to be proceeded.

Have you ever been convicted of a crime, made a plea of guilty, accepted a deferred judgment, been adjudicated, or been required to register as a sex offender? (Misdemeanor traffic violations exempted.) Yes No
If yes, please include a statement of explanation in the comments box.
Comments

Note:  required fields are in bold.

Shipping and Payment:
Payment Type:
Card Number: - - -

Expiration Date:
Credit Card Access Code:

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MESA STATE COLLEGE
Grand Junction, Colorado

READ THE STUDENT HOUSING AND DINING CONTRACT
TERMS AND CONDITIONS OF OCCUPANCY
THIS IS A LEGAL AND BINDING DOCUMENT WITH FINANCIAL OBLIGATIONS. PLEASE READ CAREFULLY BEFORE SIGNING. YOU MUST ENTER THE FOLLOWING FIELDS, INCLUDING YOUR NAME IN THE SIGNATURE BOX.

Academic Year Fall to Spring (August - May)
Spring only (January-May)
MSC Student ID Number

Last Name First Name Middle Initial Date

Signature of Student I agree to be bound by all terms of this agreement.

If you are under the age of 18 at the time you submit this online contract, a parent or guardian will need to print out the contract and mail a signed copy to Housing and Residence Life, 1100 North Avenue, Grand Junction CO 81501.