FOR OFFICE USE ONLY

Date Rec’d ____________

Deposit_______________
Cottage _______________

COTTAGE APPLICATION/AGREEMENT

Return this application with your deposit RECEIPT to:

Residential Life Office
2020 S. Ave 8E, Yuma, AZ 85365
Or you may fax it to: 928-317-5888

PLEASE TYPE OR PRINT ALL SECTIONS OF THIS APPLICATION

N/A Legal Name : Andrea Aurea Perez Ceniceros

Soc. Security/Employee ID First Middle Last

235 General Jose Moran Street, Daniel Garza, Mexico City, 11830 ( +52 )5552764972
Permanent Address (number, street, apt., city, state, zip) Permanent Phone (include area code)

07/15/1992 Female 26
Mailing Address (if different from above) Birth Date (month/day/year) Gender Age

_Fernando Reyes Diaz____________________________ ___+52 1 5531548286___

Emergency Contact (name) Emergency Contact (phone; include area code)

CONTRACT PERIOD & COACHING STATUS

DATE OF HIRE ____N/A_______ MOVE IN DATE _____N/A___ ASSIGNED SPORT _______N/A_____________________

__
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR? (Other than a minor traffic violation.)

____ YES __X__ NO (An answer of yes does not automatically disqualify you from qualifying for housing.)

If your answer is yes, you must attach to this application a detailed summary of the offense(s) from an appropriate judicial or corrections
official, including copies of police reports, sentencing reports or other evidence satisfactory to the College. Your application will be reviewed
and you will be notified in writing of the decision regarding your housing request. Failure to disclose an incident will subject you to potential
revocation of your on-campus housing.

COTTAGE AGREEMENT (Please initial next to each item to indicate understanding and acceptance)

___X___A cottage resident may not be employed full-time by the College.

___X___While no cottage resident will be charged rent for these spaces, fair market value will be reflected as compensation and taxed
accordingly.
___X__All cottage residents must abide by the same rules and regulations governing the behavioral standards and responsibilities expected of
College employees. This includes compliance with all residence hall policies and procedures. A student Code of Conduct will be given.
___X___Arizona Western College is a substance and tobacco free campus. Therefore, all alcohol, tobacco and other drugs (except as
prescribed by a doctor) are prohibited from campus.
___X___While students/players may, at times, present themselves at the cottage to visit a resident; it is the expectation that all personal and
professional business will be conducted outside of the cottage. With the exception of spouses, there are to be no overnight guests in the
cottage. No students allowed inside cottages – no exceptions.
___X___All cottage residents are expected to check-in and check-out (required two week notice) accordingly with the Coordinator or
Residential Life or their designee. All keys must be returned and the room left clean and free from damages to avoid any applicable charges.

I have read, understand and accept the terms of this Cottage Application/Agreement. I understand that any violations of College policy or this
agreement may result in disciplinary action up to and including termination of this agreement, which would result in expulsion from the
cottage.

_________________________________________ ______03/30/2019_______
Signature of Applicant Date