Housing Application

*This form WILL NOT be submitted if you do not complete the payment process at the end.  If you back out of the payment screen, you will need to complete the application again in its entirety. 

*Be aware that as each section of this application is processed in different areas, you may be asked for the same information in more than one field.

Last Name:

First Name:

Middle Name:

PJC Student ID # (if applicable):

Gender:

Date of Birth:

Address:

City:

State:

Zip:

Email:

Phone:

Semester Starting School:

In Which Year:

Proposed Major:

Are You A Smoker?

If possible, I would like to room with:

* If you have special needs, please contact the Student Housing Office at 903-782-0402 or 903-782-0433

Residence Hall Student Contract

1. I agree to remain in the college residence hall for the entire semester in which I occupy the premises by paying the deposit, being assigned to a room, and placing personal belongings in the residence hall. I understand that violation of this agreement will result in violation of the Residence Hall policy and that the withdrawal procedures will be initiated.
2. I understand that all Residence Hall students are required to purchase meal plans in the cafeteria.
3. When vacating the Residence Hall room, I agree to follow the checkout procedures. I also agree to be responsible for damage to my Residence Hall room that occurs during the time in which I am a resident. Cleaning the room and personal checkout by the Residence Hall director is considered a part of the checkout procedure.
4. I agree that, if Paris Junior College considers it necessary to refer all or part of my unpaid account balance to an attorney or collection agency for collection, I am liable for and shall pay the attorney’s fees and/or collection agency fees resulting from the referral. I agree to pay all charges and other costs, including attorney’s fees, that are allowed by Federal and State laws and regulations and that are necessary for the collection of these amounts.

Room Deposit

The room deposit is forfeited, the meals are prorated through the week of the last meal eaten, and the student must pay for the room for the entire semester at any time that the student moves from the Residence Hall either by leaving school by request of the school or for personal reasons. The refund policy is also applicable when the student withdraws from the Residence Hall without leaving school either by request or for personal reasons.

I Agree

Type Full Name For Electronic Signature

Acknowledgement and Authorization for Background Check

I acknowledge receipt of the separate document entitled “Disclosure Regarding Background Investigation” and “A Summary of Your Rights under the Fair Credit Reporting Act” and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Paris Junior College (the Company) at any time after receipt of this authorization and throughout my housing. To this end, I hereby authorize, without reservation, any law enforcement agency, state or federal agency to furnish any background information requested by Castle Branch Background (1844 Sir Tyler Drive, Wilmington, NC 28405, (888)723-4263, https://www.castlebranch.com) and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

Background Information

Last Name:

First Name:

Middle Name:

Other Names/Aliases Used:

Social Security Number:

Phone Number:

Date of Birth:

Current Address:

Address:

City:

State:

Zip:

Previous Address:

Address:

City:

State:

Zip:

Please select one of the following types of Identification.  You will also need to send a copy to Housing@parisjc.edu.

ID # For The Selection Above

State Issued:

Please click the link below to download documentation explaining Paris Junior College's background check procedures and criteria as well as a summary of your rights under the Fair Credit Reporting Act.

I Agree

Type Full Name For Electronic Signature

Release of Background Information - See College Policy FG (LEGAL)

Paris Junior College housing applicants are required to complete a Release of Background Information form. Documentation is required to obtain the criminal history record information. The required documentation includes a copy of the applicant's current driver’s license or State Identification number. A Passport or Military I.D. may be used. In addition, you must provide a $35.00 non-refundable fee. The fee is collected when this form is submitted and will be added to the $100.00 residence hall damage deposit (total payment will be $135.00). Applicants with declined housing applications may request a full refund of their damage deposit. Questions should be directed to Paris Junior College at 903.782.0433.

Have you ever been convicted of a felony or plead guilty or no contest to a felony offense?

Please explain:

Disclosure Regarding Background Information

Paris Junior College (“the Company”) may obtain information about you from a third-party consumer reporting agency for housing purposes. This information may be obtained in the form of a “consumer report” and/or an “investigative consumer report” (commonly known as a “background report”). These reports may contain information regarding your criminal history or social security verification. This information may be obtained from private and public record sources. A more comprehensive background investigation may be required pursuant to state or federal law, or contract agreement. The applicant will keep “A Summary of Your Rights Under the Fair Credit Reporting Act” for your records.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, disclosure of the nature and scope of any investigative consumer report, and to request a copy of your report. Please be advised that the nature and scope of any investigative consumer report obtained with regard to applicants for housing purposes is an investigation conducted by CastleBranch Background (CB). CB is located and can be contacted by mail at 1844 Sir Tyler Drive, Wilmington, NC 28405, and CB can be contacted by phone at (888) 723-4263.

Information about CB’s privacy policy is available at the following link: https://www.castlebranch.com/privacy-policy.

The scope of this notice and authorization is all-encompassing and allows the Company to obtain from any outside organization all manner of consumer reports throughout the course of your living in the residence hall to the extent permitted by law. Any adverse information in the background check may result in immediate removal from campus housing.

I Agree

Type Full Name For Electronic Signature

Housing Application Fees

Upon clicking the payment button below, you will be directed to the Herring Bank Payment Gateway.  

At this point, you will make the required payment for the Dorm Deposit ($100) and Background Check Fee ($35). The total amount charged will be $135.

Please allow 24-48 hours for the payment to process. Once the payment is processed, we will send you an email with a confirmation of payment.  This email will also include information on your next steps. If you have any questions please contact housing@parisjc.edu.

*This form WILL NOT be submitted if you do not complete the payment process.  If you back out of the payment screen, you will need to complete the application again in its entirety.