Student Housing Application Housing Application Step 1 of 4 25% Semester applying for:Semester* Fall Spring Summer 1 Summer 2 Year*Please enter a number from 2022 to 2025.Application InformationSocial Security Number xxx-xx-xxxxName* First Middle Last Date of Birth* MM slash DD slash YYYY Phone Number*Cell Phone NumberEmail Address* Gender* Male Female Vehicle Information Make Model License Plate State Residence Hall Preference Goins (Female) Stephens ( Male) Tyler Street (Coed) Room Type* Private Double Requested Roommate I have physical disabilities or other conditions requiring special housing.* Yes No If yes, please indicateAre you associated with any FPC team? Baseball Basketball Cheerleading Livestock Judiging Rodeo Softball Volleyball Parent or Guardian Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Emergency Phone Number*Emergency Cell Phone Number**Effective January 2010 Texas House Bill 4189 requires that incoming students, including transfer students, who live on campus must provide either evidence of vaccination against bacterial meningitis or a signed affidavit declining the vaccination prior to living on campus. Immunization records should be turned into Student Central. Students will not be allowed to move into the housing facilities until documentation is provided. A Summary of Your Rights under the Fair Credit Reporting Act,The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. • You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment- or to take another adverse action against you- must tell you, and must give you the name, address, and phone number of the agency that provided the information. • You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: • a person has taken adverse action against you because of information in your credit report; • you are the victim of identity theft and place a fraud alert in your file; • your file contains inaccurate information as a result of fraud; • you are on public assistance; • you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information. • You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from cred it bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive cred it score information for free from the mortgage lender. • You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures. • Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. • Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. • Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. • You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore. • You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688. • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. • Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfianance.gov/learnmore. States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. ADDITIONAL STATE LAW NOTICES If you live in or are applying for a job in the state of California, Maine or New York, please review these additional notices. CALIFORNIA: You may view the file maintained on you by LexisNexis during normal business hours. You may also obtain a copy of this file, upon submitting proper identification and paying the costs of duplication services, by appearing at LexisNexis’s offices in person, during normal business hours and on reasonable notice, or by mail; you may also receive a summary of the file by telephone. LexisNexis has trained personnel available to explain your file to you, including any coded information. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. MAINE: You have the right upon request, to be informed of whether an investigative consumer report was requested, and if one was requested, the name and address of the consumer reporting agency furnishing the report. You may request and receive from the Company, within five business days of our receipt of your request, the name, address and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing an investigative consumer report concerning you. You also have the right, under Maine law, to request and promptly receive from all such consumer reporting agencies copies of any such investigative consumer reports. NEW YORK: You have the right, upon written request, to be informed of whether or not a consumer report was requested. If a consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report. Required fields are printed in bold.I have read and understand My Rights under the Fair Credit Reporting Act.* I Agree Digital Signature (Full Name)* DISCLOSURE AND AUTHORIZATION FORM I certify and declare under penalty of perjury under relevant state and federal law that the information contained in my housing application is complete, true, and accurate. I acknowledge that falsification or omission of information may result in immediate dismissal or retraction of housing agreement with FPC. In consideration of Residential Housing, Frank Phillips College(FPC) may review my application for housing, I hereby voluntarily consent to and authorize FPC, or its authorized agents bearing this release or copy thereof, to obtain a consumer report for residential housing purposes. I agree that this consumer report may include any of the following: * Criminal Records, Motor Vehicle Records and/or Civil Records. I authorize all persons and organizations that may have information relevant to this research to disclose such information to FPC or its authorized agents. I hereby release FPC, its authorized agents, and all persons and organizations providing information from all claims and liabilities of any nature in connection with this research. I hereby further authorize that a photocopy of this authorization may be considered as valid as the original. I understand that I have specific prescribed rights as a consumer under the federal Fair Credit Reporting Act ('FCRA') and may have additional rights under relevant state law. I hereby certify that I have been presented with a summary of my rights as a consumer under the Fair Credit Reporting Act.• Employment Verification, Education Verification, Credentials Verification. • Personal Identity Verifications, Past Employment Verification, Reference Checks. • Criminal Records, Civil Cases, Motor Vehicle Records, Credit Report I authorize all persons and organizations that may have information relevant to this research to disclose such information to Landlord or its authorized agents. I hereby release Landlord, its authorized agents, and all persons and organizations providing information from all claims and liabilities of any nature in connection with this research. I hereby further authorize that a photocopy of this authorization may be considered as valid as the original. I understand that I have specific prescribed rights as a consumer under the federal Fair Credit Reporting Act ('FCRA') and may have additional rights under relevant state law. I hereby certify that I have been presented with a summary of my rights as a consumer under the Fair Credit Reporting Act. I have read and understand The Disclosure and Authorization Form. Agree to by: Please Note: S2Verify does not provide legal advice. The disclosure and authorization form is provided solely as an example or illustration, and it should be modified and used in accordance with your established business and compliance requirements. Finally, please ensure your legal counsel or compliance officer reviews whatever format you decide to utilize and or deploy.* I Agree Digital Signature (Full Name)* Release of Background Information Required fields are printed in bold. I have carefully read and understand this Disclosure and Authorization form. By my electronic signature below, I consent to the release of consumer reports and/or investigative consumer reports to the Company in conjunction with my student housing application. I understand my consent will apply throughout my enrollment to the extent permitted by law, unless I revoke or cancel my consent by sending a signed letter or statement to the Company. I understand that, to the extent allowed by law, information contained in my student housing application or otherwise disclosed by me before, during or after my enrollment, if any, may be utilized for the purpose of obtaining consumer reports and/or investigative consumer reports. By my electronic signature below, I also authorize the disclosure to S2Verify of information concerning my employment history, earning history, education, credit history, credit capacity and credit standing, motor vehicle history and standing, criminal history, and all other information S2Verify deems pertinent by any individual, corporation or other private or public entity, including without limitation the following: employers; learning institutions; including colleges and universities; law enforcement agencies; federal, state and local courts; the military; credit bureaus; motor vehicle records agencies; and other applicable sources. This Disclosure and Authorization form, in original, faxed, photocopied or electronic form, will be valid for any reports that may be requested by the Company. For residents of, or for jobs located in, California, Minnesota and Oklahoma only: You will be provided with a free copy of any consumer reports or investigative consumer reports on you if you check the box below.I wish to receive a free copy of any consumer report and/or investigative consumer report on me that is requested. I agree Years at Current Residence* Previous Address (if a present address less than 5 years) Street Address City State / Province / Region ZIP / Postal Code Driver's License Number State State Identification Number State Passport Number Military I.D. Number Have you ever been convicted of a felony? Have you ever pled quilty or no contest to a felony offense? Yes No If yes, please list all pending charges or convictionsAs applicant for residency at Frank Phillips College, I hereby authorize Frank Phillips College to obtain criminal history record information from any law enforcement agency or background check software which may have criminal history record information on me, including but not limited to arrests, investigations, convictions, and other reports. I hereby release Frank Phillips College and any law enforcement agency receiving a copy of authorization from liability for the release of any information to Frank Phillips College. Applicants with a pending charge or a conviction for a felony, class A misdemeanor, class B misdemeanor may be declined housing privileges by the Dean of Student Services. In addition, I certify that I have submitted correct and updated information concerning any legal issues.I have read and understand the terms and agreements from above.* I agree Applicant's Full Name* First Last Social Security Number*
