Iowa Central Application for Housing & Food Contract

Application for Housing & Food Contract, conditioned upon acceptance of Application by Iowa Central Community College Residence Life Department.

This application for Housing and Food Contract will not be processed until it is fully completed by the applicant and received by Iowa Central Community College Residence Life Department with the $125 Iowa Resident or $300 Non-Resident non-refundable application fee. Applications are processed by the Residence Life Department only during normal business hours on Monday through Friday, excluding holidays. Priority deadline for non-residents is June 1st.

Conditioned upon Iowa Central Community College acceptance of application (as described herein), the Housing and Food Contract between Iowa Central Community College and applicant is for one full academic year beginning with the fall semester and ending at the end of the spring semester or for the spring semester only (as applicant has specified below), subject to applicant complying with the Terms and Conditions of Housing and Food Contract.

Any resident hall resident who does not fulfill the terms of the Housing and Food Contract will be assessed a $600.00 Violation of Contract Fee. The Violation of Contract Fee will not apply for the following reasons: marriage, death, graduation, or if the resident notifies the College that they will be transferring before the end of the Contract Agreement or end of the semester.

Conditions of Acceptance of Application: Iowa Central Community College acceptance of this application is conditioned upon the applicant truthfully and fully providing all information requested and answering all requests, the required non-refundable application fee is received by the Iowa Central Community College Residence Life Department, and information establishes that the applicant does not have a record of criminal conviction(s), adjudication(s), plea(s), or other actions indicating behavior that could pose a risk to person and/or property and could be injurious or disruptive to the residence hall and its residents or the living environment and is not a registered sex offender. Iowa Central Community College Residence Life Department will notify the applicant within 45 calendar days after its receipt of the application whether or not the application for Housing and Food Contract has been accepted.

I understand that any non-disclosure and/or incomplete or inaccurate information by me in this application will be grounds for immediate termination of the Housing and Food Contract with requirement that I vacate the premises.

Non-Discrimination Policy

It is the policy of Iowa Central Community College not to discriminate in its programs, activities, or employment on the bases of race, color, national origin, sex, disability, age, sexual orientation, gender identify, 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 the Vice President of Human Resources, Iowa Central Community College, One Triton Circle, Fort Dodge, Iowa 50501; Telephone: 515-574-1138, Email: concerns@iowacentral.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, Telephone: (312) 730-1560 Facsimile: (312) 730-1576, TDD 800-877-8339 Email: OCR.Chicago@ed.gov.

Personal Information

Start Term:	Please select an item.
Start Year:	A value is required.
Are you a returning student?	Please select an item.
First Name:	A value is required.
Middle Name/Initial:
Last Name:	A value is required.
Sex:	Please select an item.
Address:
City:
State:
Zip Code:
SSN:
Birthdate:
Applicant's College Classification:	Please select an item.
Home Phone:	A value is required. Invalid format.
E-mail	A value is required. Invalid format.
License Plate Number:	A value is required.

Parent/Guardian Information

Name:
Address:
City:
State:
Zip Code:
Home Phone:

Honor Dorm

Are you interested in living in our Honor Apartment?
Student must have a cumulative high school GPA of a 3.25 or higher. Living the Honor Dorm this may affect your roommate preference.

Roommate/Disability Accommodations/Meal Plan

Preferred Roommate's Name:
Preferred Roommate's Academic Program:
Accommodations:	Select this option and click here if have a disability accommodation that needs to be considered in making my housing assignment. Select this option if you DO NOT have a disability accommodation that needs to be considered in making my housing assignment.
Other Questions:	Have you been dismissed from a post-secondary educational institution within the past three years? Please select an item.
	If the answer is “Yes” to the above question: I state that the following reason(s) lead to the dismissal and provide the name of the educational institution:

By submitting this Application I authorize the above named educational institution to disclose to Iowa Central Community College’s Vice President of Student Services the information from my educational records as to the reason(s) for the dismissal.

Meal Plan Options*
Housing & Food/19 meals per week - $7830.00 (2024-2025 Cost)
*subject to change after Board approval and prior beginning of contract year.

Terms and Conditions

Certification and Authorization

By submitting this form I agree to all Terms and Conditions listed below,

I certify that the above answers and the information provided herein are true and correct;

I certify that I have never entered a guilty plea to or entered an Alford Plea to or been convicted or adjudicated of a sex, domestic violence, firearms, explosive, alcohol, or drug offense or of a felony or misdemeanor offense relating to property or the person of another individual and that I am not a registered sex offender.

I authorize the educational institution, named in the answer to the post-secondary education dismissal question above, to disclose to Iowa Central Community College’s Vice President of Student Services the information from my educational records as to the reason(s) for the dismissal; and

I authorize Iowa Central Community College Residence Life Department to conduct a detailed criminal background/history check of my past. Any criminal history data concerning me that is maintained by any federal or state agency may be released as allowed by law.

Contractual Responsibilities

By submitting this form I hereby apply for Housing & Food for the academic year or the balance thereof as I have specified above. I have read and agree to abide by the terms and conditions of the Housing & Food Contract as attached. I will send the $125 (Iowa Resident) or the $300 (Non-Resident) non-refundable application fee (as applicable) by check or money order made payable to Iowa Central Community College. I understand that Iowa Central Community College's acceptance of this application is conditioned upon me truthfully and fully providing all information requested and answering all requests, the required non-refundable application fee is received by the Iowa Central Community College Residence Life Department, and information establishes that the I do not have a record of criminal conviction(s), adjudication(s), plea(s), or other actions indicating behavior that could pose a risk to person and/or property and could be injurious or disruptive to the residence hall and its residence or the living environment and that I am not a registered sex offender.

The $125 (Iowa Resident) or the $300 (Non-Resident) non-refundable application fee (as applicable) check or money order is payable to:
Iowa Central Community College

Send the application fee to:
Iowa Central Community College
c/o Director, Housing and Campus Security
One Triton Circle
Fort Dodge, IA 50501

Applicant Digital Signature: (enter name here to authorize): A value is required.

If the applicant is under the age of 18

If the applicant is under the age of majority, the parent or guardian must also digitally sign certifying that the above answers and the information provided herein are true and correct and authorizing the educational institution, named in the answer to the post-secondary dismissal question above, to disclose to Iowa Central Community College’s Vice President of Student Services the information from the applicant's educational records as to the reason(s) for the dismissal, and authorizing Iowa Central Community College Residence Life Department to conduct a detailed criminal background check of the applicant's past.

If the applicant is under the age of majority, the parent or guardian must digitally sign as guarantor below. I understand that Iowa Central Community College's acceptance of this application is conditioned upon the applicant truthfully and fully providing all information requested and answering all requests, the required non-refundable application fee is received by the Iowa Central Community College Residence Life Department, and information establishes that the applicant does not have a record of criminal conviction(s) adjudication(s), plea(s), or other actions indicating behavior that could pose a risk to person and/or property and could be injurious or disruptive to the residence hall and its residents or the living environment and is not a registered sex offender. In consideration of the approval of this contract between Iowa Central Community College and the applicant, I guarantee the performance of all the terms and conditions of the Housing & Food Contract.

Parent/Guardian Digital Signature: (enter name here to authorize): A value is required.

You must agree to the Terms and Conditions to continue. By checking the box to the left I certify that I have read and agree to the Terms and Conditions of the Housing & Food Contract. The Terms and Conditions can be viewed by clicking the link to the left.

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