NLC Residence Housing Application: Northern Lakes College

NLC Residence Housing Application

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: *

Dates accommodation is required from: *

Dates accommodation is required until: *

Select the accommodation required: *

Applicant Information:

(All fields must be completed)

Name of Program attending: *

Full-time/Part-time program: *

NLC STUDENT ID# *

Birthdate: (MM/DD/YYYY) *

Gender: *

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? *

– If yes, what year?

If yes, what location:

Any details:

Have you ever been convicted of a criminal offense? *

If yes, Reason:

Have you ever been evicted from any residence? *

If yes, Reason:

Have you ever filed for bankruptcy? *

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? *

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:

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