Follow the steps to complete your housing application online.

1. Click ‘Get Form’ button to access the Coahoma Community College Housing Application form and open it in the editor.
2. Enter your personal information. Fill out your full name in the designated fields: first, middle, and last name.
3. Provide your contact numbers. Input both your home and cell phone numbers in the respective fields.
4. Indicate your gender by selecting from the available options—either male or female.
5. Specify your marital status by selecting either single or married.
6. Input your date of birth in the requested format: month, day, and year.
7. Enter your Social Security number and ID number as requested on the form.
8. Complete your home address. Fill in your address, apartment number (if applicable), city, state, and zip code.
9. Specify your intended date of entry into the residence hall. Select the month and year you plan to move in.
10. Answer the health-related question regarding chronic ailments or physical disabilities that may affect your housing assignment. Attach a physician’s statement if applicable.
11. If applicable, indicate your preferred roommate’s name.
12. Acknowledge your understanding of the application conditions regarding housing and admission status by marking the provided checkbox.
13. Confirm your application for admission to Coahoma Community College by selecting the appropriate checkbox.
14. Indicate whether you are enclosing the required housing deposit by selecting the appropriate checkbox.
15. Answer the felony conviction question and provide clarification if necessary.
16. Lastly, fill out the insurance information and ensure you sign the application, along with the date.
17. Review your completed application for accuracy. Once verified, you can save your changes, download, print, or share the completed form as needed.

Begin completing your Coahoma Community College Housing Application online today!