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Student Housing 2017-2018

Complete this application and pay the $100 application fee in person to the Business Office. Submission of this application does not guarantee the student housing. Resident selection and room selection is based on the date of payment received by the institution. Applications are not considered complete without payment of the application fee.
Term for which you wish to enroll:
Classification at the time of enrollment:

General Information

Gender Identity

Your response to this question will be used to assist in assignment only. No applicant will be denied housing based on gender identification.
Your response to the follow question is optional and will not affect your request for housing.
Ethnic Origin

Address

Contact

Emergency Contact

Are you enrolled in full-time status, which is at least 12 credit hours for the fall or spring and at least 6 credits for the summer?
Have you lived in KCKCC Student Housing before?
I plan to participate and/or receive a scholarship in (choose one only)

Public Safety

Due to concerns about public safety, it is important for the Housing Staff to know if you have been convicted of a criminal offense. Failure to answer these questions truthfully will result in the immediate dismissal of a housing application or cancellation of a housing contract. Permission to live in Student Housing with a criminal conviction will be determined on a case-by-case basis, dependent upon the circumstances of the conviction. If you mark “yes” to any of the following questions, please email the Director of Housing explaining the offense at ttompkins@kckcc.edu.
Have you ever been convicted of and/or pled “guilty” or “no contest” to any felony regardless of whether such action requited in jail or prison time served and/or deferred adjudication?
Have you ever been convicted of and/or pled “guilty” or “no contest” to any misdemeanor regardless of whether such action resulted in jail or prison time served and/or deferred adjudication?
Are you currently on probation, parole or suspended for any of the above?

Room Choice

All rooms are assigned on a first-come, first-served basis. Acceptance of the contract does not guarantee assignment to a specific building, room, or roommate.
No assignment is made on the basis of race, religion, color, disability, national origin, ancestry, and, to the extent specified by law, age or veteran status. Students who need assistance with building or room assignments are encouraged to contact the Supervisor of Student Housing.
Floor Type
Housing Building
Bedroom Request

Roommate Request

Note: The KCKCC Housing staff reserves the right to change student room assignments as necessary. The Supervisor must approve all requests for changes in assignments.

Health

Please use the space below to list any medical conditions you have. Examples would be allergies, seizures, depression, or any condition for which you take prescription medication. This information will not be used to determine housing eligibility; it will solely be used so the staff may be aware of any health or safety issues to better serve the residents. Attach a separate sheet if necessary.
KCKCC prohibits discrimination on the basis of race, religion, color, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, family medical history or genetic information, political affiliation, military service, or other non-merit based factors. All college actions and policies comply with all state, federal and local laws and regulations. For any inquiries regarding the non-discrimination policies: Human Resources, Kansas City Kansas Community College, 7250 State Avenue, Kansas City, Kansas 66112, Telephone (913) 288-7646.
  • © Kansas City Kansas Community College
  • 7250 State Avenue
  • Kansas City, KS 66112
  • 913-334-1100

  • An Equal Opportunity Educational Institution