Fillable PETITION FOR OFF-CAMPUS RESIDENCE ALL OFF-CAMPUS HOUSING MUST (Western Texas College)

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PETITION FOR OFF-CAMPUS RESIDENCE ALL OFF-CAMPUS HOUSING MUST (Western Texas College)

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PETITION FOR OFF-CAMPUS RESIDENCE
ALL OFF-CAMPUS HOUSING MUST BE APPROVED IN ADVANCE!!!
MUST MEET AT LEAST ONE OF THESE CRITERIA:
1. Over 30 hours of college credit
2. Will be living with
a blood relative
3. Student is 21 years of age or older
4. Student has a medic
a
l condition that precludes institutional living
NAME:_______________________________________AGE: ________DATE OF BIRTH:__________
PARENT’S NAME:_____________________________________________________________________________
PARENT’S ADDRESS:_______________________________________________________________
______________________________________________________
_________________________
PHONE #:_____-______-______ (Home) ______-______-______ (Work) ______-______-______(Cell)
Are you receiving any financial aid from Western Texas College? YES______ NO_______
(Specify Type) __________________________________________________________________
Will you be living with relatives? YES_____ NO_____ If yes, list the following info:
RELATIVE’S NAME:________________________________________PHONE#:______-______-______
ADDRESS:_____________________________________RELATIONSHIP:_________________________________
CITY:_________________________________________
Signature of Parent (if student is under 21)______________________________Date:______________
Signature of Student ____________________________________________________ Date:_____________
Approved by:_____________________________________________________________Date:_____________
Return to the Office of: Ralph
Ramon
Assoc. Dean of Student Services
Western Texas College
6200 South College Avenue
Snyder, Texas 79549
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PETITION FOR OFF-CAMPUS RESIDENCE ALL OFF-CAMPUS HOUSING MUST (Western Texas College)

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Completed 27 July 2020

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