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Personal Information
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Classification
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Freshman
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Transfer
Name
(Required)
First
Last
What is your date of birth?
(Required)
Email
(Required)
Phone
(Required)
Rust College I.D.
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
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Aruba
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Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
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Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
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Denmark
Djibouti
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Ecuador
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Faroe Islands
Fiji
Finland
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Indonesia
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Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
Latvia
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Nigeria
Niue
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Northern Mariana Islands
Norway
Oman
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Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Will you bring a vehicle?
Yes
No
Unsure
Emergency Contact
Parent or Guardians Name
(Required)
First
Last
Relationship to Student
(Required)
Parent or Guardians Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Türkiye
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Do you have any illness/allergies/medications that require immediate attention?
(Required)
Yes
No
If yes, please list
If you have Health Insurance please provide it's name
(Required)
Add
Remove
Will you operate a motor vehicle on campus?
(Required)
Yes
No
Hobbies / Special Interest / Talents
(Required)
Rust College’s property insurance is not designed to cover the personal effects of students (i.e. stereo and computer equipment, clothes, and other personal items). It is important that students understand that the purchase of property insurance for personal items is their responsibility. We recommend that you contact National Student Services, Inc. for information on student’s personal effects property insurance. NSSI offers affordable personal property coverage for purchase by students and will be pleased to provide coverage. They may be reached at 1-800-252-6774 or you may apply online at www.nssinc.com.
HOUSING CONTRACT
1. Rust College agrees to house the student named on this application and the student agrees to live in Rust College campus accommodations, a space for residential purposes only, in the residence halls located in Holly Springs, MS for an academic year or the remainder thereof, beginning when residence halls open for student residents according to the calendar published by the College. This agreement ends 24 hours after the student’s last final examination or on the last day the residence halls are open, whichever comes first. The residence halls will be closed and may not be occupied during Thanksgiving and Christmas vacations. Upon checking out of the residence hall, the student agrees to follow the checkout procedures as directed by the Residence Education Director and as provided in The Residence Life Handbook
2. Keys to assigned rooms will be issued conditionally, based upon the ability of the student to complete registration prior to the final date. Persons who do not complete registration must move from campus housing within 24 hours of that date. A daily rate of $100 shall be billed for persons who do not complete registration.
3. The College reserves the right to make room assignments and re-assignment as considered necessary. All rooms are designed for 2 persons (E.L. Rust, Wiff, Gross) or 4 persons (Davage-Smith, Emma Elzy). Residents are not permitted to allow any person who is not properly registered to stay in his/her room without the permission of the Residence Hall Director. Occupants are not allowed to have any animals/pets (dogs, cats, fish, etc.). The College may remove a student from the residence hall for a breach of this agreement or a violation of College policy. If for any reason, a student withdraws from the College or moves from the residence hall, the student will be charged for the time of occupancy.
4. The student shall permit any authorized official(s) of the College to enter the student’s room at all reasonable times for the purpose of inspecting the room or for the purpose of enforcing reasonable rules and regulations ensuring the safety, welfare, and comfort of all students and that of the entire College community. The College reserves the right to conduct an unannounced room search at any time, with or without the student’s consent, if there is just cause for the search. Illegal items found during the inspection or search may be confiscated.
5. The student shall use reasonable diligence in the care of his or her room and common areas of the residence hall. The student may not make any alterations to College property without the written consent of the Residence Hall Director or his or her designee. The student agrees to pay for damages caused to College property as a result of negligence, carelessness, accident or abuse. Payment is due upon demand. In common areas, if the identity of the person responsible for damages to College property cannot be determined after diligent investigation, the appropriate Residence Hall Director may prorate the cost of repair or replacement among all or any portion of the residents of the hall as he or she may deem fair. A STUDENT WHO FAILS TO PAY FOR DAMAGE AS REQUIRED ABOVE WILL NOT BE PERMITTED TO REGISTER, MOVE IN, GRADUATE, OR BE ISSUED AN OFFICIAL TRANSCRIPT UNTIL SUCH DAMAGE CHARGES ARE PAID.
6. The College shall not be liable for any damages or losses to person or property caused by other persons, theft, burglary, assault, vandalism or other crimes, fire, flood, water leaks, wind, rain, hail, ice, snow, smoke, explosions, interruptions of utilities, or other natural phenomena. The College strongly recommends that the student secure insurance to protect against loss from any of the above occurrences (National Student Services, Inc. www.nssi.com). The student agrees to hold blameless and indemnity the College for any claims of damages payable as a result of negligence on the part of the student.
7. The student agrees to participate in the Wellness, Life skill, Health, Safety and Community Standards meeting, and residence hall fire and emergency evacuation drills.
8. College housing reserves the right to assign applicants and students to available space and, in its sole discretion, change such assignment at any time. College housing also reserves the right to change an assignment or terminate the privilege of housing for anyone who: (1) in the opinion of the Dean of Student Affairs or his or her designee, has demonstrated behavior that significantly disrupts or poses a danger to the residence hall environment, or (2) has received such a sanction through the conduct process.
9. Any and all property of the student which may be left on college property after the termination of this agreement may be handled, removed, or disposed of at the risk and expense of the student, and the College shall in no event be responsible for.
10. The College may terminate this agreement if the student: (a.) fails to pay room and/or board or other charges when due; (b) fails to be enrolled in the College, or (c) fails to obey the terms of this agreement, including College policies.
11. These conditions for room occupancy constitute the entire agreement between the student and the College. No oral agreements have been made. No amendments to this agreement are valid unless in writing and signed by both the student and the College.
Consent
(Required)
I have read and understand the terms of the Conditions for Room occupancy for the residence halls at Rust College. I agree to adhere to the policies of the College as set down in The Residence Life Handbook and Code of Conduct.
Signature
Date of Application Submission
(Required)
Pay Housing Fee below
Student Housing Reservation Fee
New Student $150.00 USD
Returning Student $100.00 USD
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