Information Your application will be submitted online directly to the Facilities Department. Accommodations are limited and will be leased on a first-come, first-served basis. The conditional acceptance of this application depends on the information obtained and reviewed. Full acceptance will occur once the security deposit has been paid in full. The security deposit is refundable upon a tenant's present check-out with no indicated damages. For information or assistance in completing this application, please call (780) 849-5752. Accommodations Required Must be completed by all applicants. Please select the location of where accommodations is required: * - Select One - Slave Lake Wabasca Grouard Dates accommodation is required from: * Dates accommodation is required until: * Select the accommodation required: * - Select One - Single bedroom in townhouse/shared living space (Co-ed) (Available in Slave Lake, Wabasca, and Grouard) Single bedroom in townhouse/shared living space (Co-ed), Barrier Free (Wheelchair accessible) (Available in Slave Lake only) Family Furnished (3 bedrooms) (Available in Grouard only) Family Furnished (4 bedrooms) (Available in Grouard only) Family Unfurnished (3 bedrooms) (Available in Grouard only) Applicant Information: (All fields must be completed) Name of Program attending: * Full-time/Part-time program: * - Select One - Full-time Part-time NLC STUDENT ID# * Birthdate: (MM/DD/YYYY) * Gender: * - Select One - Male Female First Name: * Middle Name: * Last Name: * Phone: (XXX-XXX-XXXX) * Alternate phone: (XXX-XXX-XXXX) Email: * Street address: * City: * Province: * Postal Code: (XXX-XXX) * Length of Residency at above address: (Years/Months) * Have you previously lived in NLC Student Residence? * - Select One - Yes No – If yes, what year? If yes, what location: - Select One - Slave Lake Grouard Wabasca Peace River Any details: Have you ever been convicted of a criminal offense? * - Select One - Yes No If yes, Reason: Have you ever been evicted from any residence? * - Select One - Yes No If yes, Reason: Have you ever filed for bankruptcy? * - Select One - Yes No If yes, Reason: Reference: Must be a previous Landlord or Professional Character Reference (Can not be family). Name of Landlord: * Phone: (XXX-XXX-XXXX) * Name of 2nd Reference: * Phone: (XXX-XXX-XXXX) * Relationship to you? * Dependent Information NOTE: Only to be completed by those requesting family residence. Marital Status: * - Select One - Single Living Common-law Married Seperated Divorced Widowed Spouses full name: Is your spouse attending the college? - Select One - Yes No If yes, his/her NLC STUDENT ID# List all dependents living with you: (Please list Name - Relationship and Age of each dependent) Number of dependents: Applicant Declaration Must be completed by all applicants - please read carefully: I certify that the information provided by me is true and that no relevant information has been withheld. I understand that any or all of this information may be verified in order to process my application for residence services. I also agree that I will abide by all College rules and regulations if I am accepted into the Student Residence. I acknowledge that I have read and understood the Applicant Declaration in its entirety and agree to abide by them. * Declaration read and confirmed by applicant: Name of Applicant: * Date signed: * Protection of Privacy Your personal information is collected under the authority of the Post-Secondary Learning Act and Section 33© of the Freedom of Information and Protection of Privacy Act (F.O.I.P.) and is protected under the latter Act. Information on this form is used to determine your eligibility for program(s) or service(s), manage your enrollment, contact you after you leave, evaluate effectiveness or marketing, and generate statistics and reports. If you have any questions about the collection and use of this information, please contact the FOIP Coordinator at 1 (780) 751-3282. I hereby confirm that I have read and understood the Protection of Privacy Statement in its entirety. * Protection of Privacy read and confirmed by applicant: Leave Blank
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