Fillable NDSCS Apartment & Dining Application (North Dakota State College of Science)

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NDSCS Apartment & Dining Application (North Dakota State College of Science)

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NDSCS Apartment & Dining Application
• Please fill out this form and email it to ndscs.residencelife@ndscs.edu. After sending email, call 701-671-2224 to process $50
nonrefundable application fee over the phone.
• ACCOMMODATIONS: If you require accommodations with your room or meal plan due to a documented disability, contact
Accessibility Services at 701-671-2623.
• Please be aware that Residential Life reserves the right to deny placement due to: Conduct or criminal history of anyone
living in the unit and/or unpaid balance after Wildcat Fee Payment days of the previous semester.
Legal Name_______________________________________________________________________________ Gender ______________
Last First Middle
Age________ Date of Birth ______ /_______ /_______ Email address______________________________________________________
Home
Address________________________________________________________________________________________________________
Street City State Zip Country (if not USA)
Home Phone (______) _________________________________ Cell Phone (______) ________________________________________
When do you want to start housing?
(Select One) Fall (Aug – Dec) Spring (Jan – May) Summer (June-July) Year: 20______
Emergency Contact: _____________________________________________________________________________________________
First Name Last Name Phone Number Relationship to you
Check box by your mobile carrier to receive important housing notifications via text message from Residential Life!
(Message & data rates apply)
AT&T Boost MetroPCS Nextel Sprint StraightTalk T-Mobile Verizon Other______________
PLEASE COMPLETE BACK PAGE OF APPLICATION
Student ID #____________________
Are you a student athlete?
Yes
No
*If yes, a letter of recommendation from your coach must
accompany this application.
*Students that are in a program that requires them to be away from
campus during the semester will not be provided a discounted rental
rate while away from campus.
DINING PLAN - Please select your dining plan. For out-of-state
students to receive in-state tuition rates, they must live on campus
and carry either a 160, 225 or 300 dining plan.
80 Dining Plan/semester – averaging 5 meals per week
160 Dining Plan/semester – averaging 10 meals per week
225 Dining Plan/semester – averaging *14 meals per week
300 Dining Plan/semester – averaging *19 meals per week
40 Wild Grounds Café – 40 total meals
No Dining Plan
*225 & 300 dining plans include $50 in dining dollars for use in the
Wild Grounds Cafe or Flickertail Dining Room. The 160, 225 & 300
dining plans include 10 parent/guest meals per semester. The 80
dining plan includes 5 parent/guest meals per semester. Requests
for dining plan changes must be received prior to Wildcat Payment
and Refund days.
SUMMER DINING PLAN – Please select your summer dining plan.
Dining Plan 1 – 78 meals/semester. Average 2 meals per day.
Dining Plan 2 – 39 meals/semester. Average of 1 meal per day.
No Dining Plan
*Summer dining plans are available Monday – Friday. There is
no meal service Friday evening or weekends.
Students must meet one of the following requirements to live in a
campus apartment. Please place an “X” by the requirement you meet:
_____ Student has lived in an NDSCS residence hall for at least two
semesters
_____ Student is married (attach copy of marriage certificate)
_____ Student has a child that resides with them (
attach copy of
birth certificate)
_____ Student will be 21 years of age or older at the time of placement
_____ Student has completed 24 or more college credits (no dual
credit, PSEO, or AP completed while in high school)
Indicate your apartment preference by placing a 1 next to your first
choice, 2 next to your second choice, etc. (See back page for list of
apartment features)
_____Northwest Apartments _____College Townhomes – furnished
_____Southeast Apartments _____College Townhomes – unfurnished
Are you married:
Yes No
Spouse’s Name: _________________________________________
Do you have minor children who will reside with you? Yes No
How many/Names: _________________________________________
ROOMMATE REQUESTS - Requests for a specific roommate must be
mutual. Requests will be accepted but cannot be guaranteed.
Roommates Name & Hometown
_____________________________________________________
NDSCS Apartment Application
For the safety and security of the NDSCS community, all students applying to the North Dakota State College of Science apartments
MUST ANSWER THE FOLLOWING QUESTIONS. An affirmative response to any of the following questions will not automatically prevent
an assignment, but you will be asked to provide additional information. The information will be reviewed by the Department of Residential
Life to review possible effects on campus safety. Any falsification or omission of the data may result in a denial of housing; rescission of an
offer for an apartment; removal from housing; or other appropriate sanctions. Please complete the following questions as they pertain
to you and/or any family member who will reside in the apartment.
If you answer “Yes” to any of the following questions, please attach the police report relating to the offense. You may also
include a personal narrative explaining the nature of the offense(s) and surrounding circumstances. Residential Life may request
additional documentation prior to making an assignment.
1. Have you, or anyone who will be residing with you, pled guilty (or no contest) to or have otherwise been convicted of a crime in
any court, excluding minor traffic violations?
No Yes (If “Yes”, please indicate ALL states, cities, counties, dates of convictions and attach official police reports).
State _________ City _______________________ County ____________________________ Date ____________________
State _________ City _______________________ County ____________________________ Date ____________________
2. Are you or anyone who will be residing with you, required to register as a sex offender in any state?
No Yes (If “Yes”, please indicate ALL states, cities, counties, dates of convictions and attach official police reports).
State _________ City _______________________ County ____________________________ Date ____________________
3. Have you, or anyone who will be residing with you, been dismissed and/or suspended from a college or university for disciplinary
reasons within the last five (5) years? Suspension is defined as a sanction imposed for disciplinary reason that results in a
student leaving school for a period of time less than permanently. Dismissal from a college for disciplinary reasons is defined as a
permanent separation from an institution of higher education on the basis of conduct or behavior.
No Yes Institution dismissed or suspended from __________________________ Date of Suspension ______________
REQUIRED SIGNATURE: By providing my signature below: I understand the information presented on this form will be used in
evaluating my application for housing to a North Dakota University System Institution. I certify that all statements on this application are
complete and true as of this date. I understand that this is an application for the duration of the entire academic year. I have read and
agree to abide by the general conditions of this Application Contract and to the terms and conditions of the current version of the College
Townhomes & Campus Apartment License Contract found at ndscs.edu/residential-life/forms and have included my $50 apartment
application fee. I understand the content of the license/contract is subject to change.
I understand if I choose to cancel my fall housing and
dining reservation, I must do so by contacting Residential Life on or before August 1
st
. If I choose to cancel my spring housing and dining
reservation, I must do so prior to the first day of classes in the spring semester. I understand that if I cancel after the cancellation date, I
will incur a $50 late cancellation fee.
Student ______________________________________________Date ____ /____ /____ Parent ______________________________________________
(Student Signature) (Parent signature required if applicant is under 18 years of age.)
Apartment Housing Options
*All units include:
• Two Bedrooms – 1 Bathroom
• Full-size refrigerator
• Stove
• Unlimited access laundry
• Wireless Internet
• Cable television
• All utilities included
FOR COLLEGE USE ONLY
Registered? Yes No
BAO ___________ CoCo ___________ Credits ______________
Check#_________________ Cash __________ Credit Card ____________ Payment Date _______ / ______ / ________
________
Custom Attributes
_______
Application List
_______
Application Fee Billed
Northwest Apartments
• Located north of Blikre Activities Center
• Family housing
• Unfurnished
• Air conditioning
Southeast Apartments
• Located northeast of the Blikre Activities
Center
• Family housing
• Unfurnished
• Air conditioning
College Townhomes
• Located north of the Southeast
Apartments
• Split level units
• Select units are furnished with:
o Two extra-long twin
beds
o Two desks with chairs
o Two dressers
o Dining table with chairs
o Small sofa
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NDSCS Apartment & Dining Application (North Dakota State College of Science)

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Completed 2 October 2020

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