NDSCS Residence Hall Housing & Dining Application
Mail this form to NDSCS Residential Life, 800 6th Street North, Wahpeton, ND 58076 and include the $25 non-refundable housing
application fee. ACCOMMODATIONS: If you require accommodations with your room or meal plan due to a documented disability,
contact Accessibility Services at 701-671-2623.
Legal Name_____________________________________________________________________________________________________
Last First Middle
Preferred Name (if different from legal name) _____________________________________________________ Gender ______________
Age________ Date of Birth ______ /_______ /_______ Email address______________________________________________________
Home
Address________________________________________________________________________________________________________
Street City State Zip Country (if not USA)
Home Phone (______) _________________________________ Cell Phone (______) ________________________________________
Check box by your mobile carrier to receive important housing notifications via text message from Residential Life!
(Msg & data rates apply)
AT&T Boost MetroPCS Nextel Sprint StraightTalk T-Mobile Verizon Other______________
When do you want to start housing? (Select One) Fall (Aug – Dec) Spring (Jan – May) Year: 20_____
Summer housing requires a separate application. To find this form, visit ndscs.edu/residential-life.
Emergency Contact: _____________________________________________________________________________________________
First Name Last Name Phone Number Relationship to you
REQUIRED SIGNATURE: By providing my signature below:
I understand the information presented on this form will be used in evaluation my application for housing to a North Dakota University System institution. I
certify that all statements are complete and true as of this date. I understand that this is an application for the duration of the 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 License for Residential
Halls and Contract for Dining Services found at ndscs.edu/residential-life/forms and have included my $25 residence hall 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 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. I give permission to Residential Life to release my
contact information (name, cell phone, and email) to my assigned roommate.
Student ______________________________________________Date ____ /____ /____ Parent ______________________________________________
(Student Signature) (Parent signature required if applicant is under 18 years of age.)
Student ID #____________________
RESIDENT ASSISTANT INFORMATION - Resident Assistants (RAs)
are student staff that live in the residence halls and serve as leaders and
resources for residents. The benefits include free single room, monetary
stipend and leadership training.
Are you interested? Yes No
DINING PLAN - Please select your dining plan. All first year students
must live on campus and carry either a 160, 225 or 300 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. If you are
required to have a dining plan and you fail to select one, you will be
assigned a 225 dining plan.
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
*225 & 300 dining plans include $50 in dining dollars for use in the Wild
Grounds Cafe or Flickertail Dining Room. All dining plans include 10
parent/guest meals per semester. Requests for dining plan changes
must be received prior to Wildcat Payment and Refund days.
RESIDENCE HALL PREFERENCE – Indicate your hall
preference by placing a 1 next to your first choice, 2 next to your
second choice, etc. Please select a minimum of three hall
choices. See back of page for description of hall features.
Male Hall
Female Hall Co-ed Halls
_____Schulz ______Walton ______Forkner
______Robertson ______Nordgaard
______Riley
ROOMMATE REQUESTS - Requests for a specific roommate
must be mutual. Requests will be accepted but cannot be
guaranteed.
Please list your requested Roommates Name & Hometown:
________________________________________________
Check#_________________ Cash __________ Credit Card ____________ Payment Date _______ / ______ / _______
_______App Received/Date ________Custom Attributes Set ________Dining Plan Set ________ Hall Choices _______ Application Fee Billed
