Residence Hall Application/Agreement

Thank you for your interest in student housing at Lassen Community College. This Application/Agreement requires a $50 nonrefundable application fee which will be transferred into Security Deposit upon check in.

The monthly rate for a Non-Renovated Room will be $450 per month ($2,250 per semester for a two-person room and $4,500 per semester for a single person room when available) with a $450 security deposit. The monthly rate for a Renovated Room will be $500 per month ($2,500 per semester for a two-person room and $5,000 per semester for a single person room when available) with a $500 security deposit.

Term *

Student ID/Social Security Number *

Legal First Name *

Legal Last Name *

Permanent Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Gender originally listed on birth certificate *

Male

Female

Date of Birth * +

Are you currently 18 years or older? *

Yes

No

Are you current or former foster youth? *

Yes

No

What is your intended major? *

What sport do you play? *

Do you have any medical conditions we should be aware of? *

Reidents are required to show proof of immunity against Measles, Mumps, Rubella, Varicella (Chicken Pox), Tdap (pertussis) and Meningitis ACYW. Please upload Immunization Records: *

Select Room Type *

Renovated ($500/month)

Non-Renovated ($450/month)

* Renovated Rooms are limited and available on a first come first serve basis.

Request for single room (based on availability) *

Yes

No

If you have a preferred roommate, please state their name below:

$50 Nonrefundable application fee which will be transferred into Security Deposit upon check in.

Click here to complete Credit Card Authorization

Upload Credit Card Authorization Form *

Please sign below *

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