Allen County Community College

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ACCC Home

When will you need housing at Allen?

Year:

Fall

Spring

Name


Last	First	Middle

Social Security Number

Date of Birth

Gender

Female

Male

Applicant's Permanent Address


Street	City


County	State	ZIP

Email Address

Phone Numbers


Home Phone		Day Phone

Parent or Legal Guardian Information

Name


Street	City


County	State	ZIP

( )		( )
Home Phone		Day Phone

If you have received an athletic/activity
scholarship, please list:

READ BEFORE SUBMITTING!!

You must Apply for Admission to Allen Community College and be accepted before this application will be considered:

Room assignments will not be made until we have the $125.00 deposit and this form completed and submitted. (Make your check payable to Allen Community College or pay online here.) This deposit is non-refundable after August 1st.

By submitting this form you agree to the following.

If I am accepted as a resident of the Allen Community College Residence hall, I agree to comply with all the regulations of the Residence Hall and of the College.