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 set 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
Electricity is an added expense
FOR COLLEGE USE ONLY Registered? Yes No BAO ___________ CoCo ___________ Credits ______________
Check#_________________ Cash __________ Credit Card ____________ Payment Date _______ / ______ / ________
_______Application Fee Billed ________Custom Attributes _______ Application List
Northwest Apartments
Located north of Blikre Activities Center
Family housing
Unfurnished
Air conditioning
Playground equipment
Southeast Apartments
Located northeast of the Blikre Activities
Center
Family housing
Unfurnished
Air conditioning
Playground equipment
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 4 chairs
o Small sofa
