FVSU-Housing-Application-2014-2015-update

Fort Valley State
University
Office Use Only Receipt#:
Room Assignment:
Received by:
Date Received:
Department of Residential Life
A State and Land Grant University 1005 State University Drive Fort Valley, GA 31030
University System of Georgia
Fort Valley State University Housing Application
Fall 2014 and Spring 2015
Directions:
*Please read & complete all of the sections carefully to insure you provide the correct information.
APPLICANT’S INORMATION:
Classification:
Incoming Freshman
Returning Freshman
Graduate
Sophomore
Junior
Senior
Transfer
Applicant’s Name:
Student ID#
(Please print) Last First Middle
Permanent Mailing Address: _
City: State: Zip Code:
Sex: M F Date of Birth (MM/DD/YYYY): / /
Home Phone# ( ) - Cell Phone# ( ) - Work # ( ) -
Applicant’s Email address:
Do you have any physical disabilities or conditions warranting special consideration in making your housing
assignment YES NO
If yes, you must present documentation from the FVSU Office of Differently Abled Services. The contact number
is 478-825-6744.
APPLICANT’S BACKGROUND INFORMATION:
Do you have any prior student disciplinary action on record Yes
If yes, summarize each incident:
No
APPLICANT’S GUARANTOR’S INFORMATION (if under the age 18):
Guarantor’s Name:
(Please print) Last First Middle
Street Address:
City: State: Zip Code:
Home Phone# ( ) - Cell Phone# ( ) - Work # ( ) -
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PLEASE NOTE:
*You must be fully accepted into the university before applying for housing. No assignments will be made
until the student has registered for classes, receipt of the non-refundable $200 room reservation, and
signed application and housing contract for the correct academic year.
** Room and Board charges reflect projected estimated cost. All fees are subject to change per final approval by the Georgia
Board of Regents on or before July 1st of each year. Fort Valley State University and the Georgia Board of Regents reserve the
right to charge rates listed here-in or to add new fees whenever such increase or additions become necessary. Room and board
fees are assessed separately each semester.
APPLICANT’S HOUSING PREFERENCE: Please rank your preferences 1-3 with 1 being your 1 st choice:
INCOMING FRESHMEN RESIDENTIAL OPTIONS:
Wildcat Commons:
4 bedrooms, 2 bathrooms Suite: $2,469 per semester
4 bedrooms, 2 bathrooms Semi-Suite $2,305 per semester
3 bedrooms, 1 bathroom Semi-Suite $2,139 per semester
Traditional Housing:
Single Occupancy in Traditional Housing
Double Occupancy in Traditional Housing
Ohio Hall:
Double Occupancy in Traditional Housing
$2,305 per semester
$2,246 per semester
$2,469 per semester
UPPERCLASS RESIDENTIAL OPTIONS:
Wildcat Commons:
4 bedrooms, 2 bathrooms Apartment: $2,796 per semester
2 bedrooms, 2 bathrooms Apartment: $3,191 per semester
4 bedrooms, 2 bathrooms Suite: $2,469 per semester
4 bedrooms, 2 bathrooms Semi-Suite $2,305 per semester
Traditional Housing:
Single Occupancy in Traditional Housing
Double Occupancy in Traditional Housing
Ohio Hall:
Double Occupancy in Traditional Housing
$2,305 per semester
$2,246 per semester
$2,469 per semester
FORT VALLEY STATE UNIVERSITY MEAL PLAN INFORMATION:
Wildcat Silver Meal Plan plus $150 wildcat cash --- $1,621/ per semester (Mandatory for all residents residing
in Housing, residents in WC1 & WC2 are allowed to reduce their meal plans to the 1 meal per day by
completing a meal change request form)*Unlimited access to the Food Service Center seven days a week during
operating hours, and $150 in Wildcat Cash per semester.
APPLICANT’S ROOMMATE PERFERENCE:
*All students must agree to be roommates, must be admitted, and must pay at same time for roommate requests to
be honored. All students must also choose the same room option. All assignments will be made based on
availability and at the discretion of the Residential Life Staff.
Roommate Name:
Student ID#
(Please print) Last First Middle
APPLICANT’S EMERGENCY CONTACT INFORMATION:
Name:
Street Address:
Relationship:
Home Phone# ( ) - Cell Phone# ( ) - Work # ( ) -
DISCLAIMER STATEMENT
Housing assignments are based on first come, first serve availability. Lack of residential space and other
unexpected circumstances may cause changes in your housing assignment.
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Fort Valley State
University
Department of Residential Life
A State and Land Grant University 1005 State University Drive Fort Valley, GA 31030
University System of Georgia
Residential Life Housing Contract 2014-2015
PLEASE NOTE: Please read the housing contract carefully as it is a legally binding document. Mail all
forms to the Office of Residential Life. Visit the FVSU Website at www.fvsu.edu for additional information.
1. Period of Contract. The period of this housing contract is the academic year 2014-2015. An academic
year consists of a consecutive fall and spring semester. If Student enters after the beginning of the
academic year, this agreement binds Student for the remainder of the academic year. Student expressly
acknowledges that this housing contract binds Student for the complete academic year.
_________ (applicant initial) __________ (parent initial)
2. Housing Application Fee. A non-refundable room reservation fee of $200.00 must be paid by Student
prior to assignment of housing. (applicant initial) (parent initial)
3. Cancellation/Exemption. Residential Life considers only those applicants for release who have submitted
the appropriate documentation and for who continued hall/apartment/suite residence would cause extreme
hardship (medical, death or change in marital status). There will be a fee per resident to break the Housing
Contract equal to 50% of the room rental fee. (applicant initial) (parent initial)
4. Housing Rental Fee. Student is obligated to pay a housing rental fee to FVSU pursuant to this contract.
This rental fee covers academic year 2014-2015 and is payable as specified by FVSU housing regulations.
5. Assignment of Housing. FVSU retains full authority with respect to the assignment of specific housing to
Student although it agrees to consider Student’s preferences as one factor in determination of housing
assignments.
6. Required Campus Residence. Student acknowledges that FVSU policies requires all full-time students
with less than 60 credit hours and under the age of 21 years old to reside on campus unless specifically
exempted pursuant to university policies. Further, all students who have a permanent home address outside
of 50 miles from the University are required to live on campus. Failure to submit a housing application
will not cancel your obligation to live on campus.
7. Meal Plan. Student further acknowledges that FVSU policy requires residents of WC 3 – WC 7 and
Traditional housing to participate in the Wildcat Silver meal plan unless otherwise approved by FVSU.
Residents in WC1 & WC2 are allowed to reduce their meal plans to the 1 meal per day by completing a
meal change request form.
8. Guarantor. Student under the age of 18 acknowledges that FVSU policy requires that his or her
obligations pursuant to this contract must be guaranteed by a responsible adult acceptable to FVSU unless
specifically exempted by FVSU policy.
9. Housing Policies and Regulations. Student agrees to abide fully with all FVSU housing policies and
regulations in force at the time this contract is agreed to, as well as all revised housing policies and
regulations placed into effect after this contract is agreed to so long as such revised policies and regulations
are reasonable and posted in accordance with FVSU standing requirements. Violation of an FVSU housing
policy or regulation may subject Student to FVSU disciplinary action pursuant to the FVSU Code of
Student Conduct. Please visit Residential Life’s Webpage for additional information.

10. Student acknowledges that conflicts between the student resident handbook and the housing contract
agreement will be superseded by the housing contract agreement.
11. Theft. The University is not responsible for any personal property loss, regardless of the reason, including
damage caused by employees in the performance of their work. It is suggested that students obtain
insurance protection against the risk of loss. Please refer to the link web address for additional
information. www.nssi.com. (applicant initial) (parent initial
12. Damages. Each resident shall be responsible for damage to or loss of any University property in his/her
assigned room. Damage(s) to public area will result in a group assessment when the individual(s)
responsible are not identifiable.
13. Transfer or Assignment of Contract. The Housing Contract may not be transferred or reassigned by
Student to another person.
14. Mail Box. Student acknowledges that FVSU policy requires that all residential students acquire an
on campus mailbox from the Post Office that is located in the Lyons Student Center. Please report
to Post Office to obtain your mailbox.
15. Prevailing Law. This agreement is subject to Georgia law and policies of the Board of Regents of the
University System of Georgia.
Applicant Signature
Date
Parent (Guardian) of Applicant Signature
Date
A Wildcat Community: “Your Home Away From Home”.
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