Name Student Number Birth Date* (YY MM DD) Gender M F
*if under 19 yrs, a parent or guardian must ll out Parental Consent/Release form
Permanent Address City Province Postal Code
Email Home phone Work phone Cell Phone
Program Start Date (
YY MM DD) End Date (YY MM DD)
Expected occupancy start date (
YY MM DD) Expected occupancy end date (YY MM DD)
I am requesting: I would prefer an assignment to:
1-bedroom unit $1105/month/occupant Dawson Creek ONLY Unit equipped for physically challenged
2-bedroom unit $585/month/occupant Quiet unit
4-bedroom unit $520/month/occupant Social unit
family 2-bed unit $1105/month Type of Stay (fee is non-refundable)
family 4-bed unit $1255/month NLC Student (application fee $50)
All Residents must also pay a Damage Deposit ($200/occupant) Non-NLC Student (application fee $100)
Individuals with whom you would like to reside:
Signature Date (YY MM DD)
Incorrectly completed applications will be returned to the location of origin for correct completion. This may delay room reservation or booking.
Deposit amount paid $
Cheque Cash Visa MasterCard
Room/Unit assigned Date (
YY MM DD) Initials
Northern Lights College reserves the right to modify or cancel any program, timetable, fees, or objective without notice or prejudice.
Student Services
Dawson Creek Campus
11401 - 8th Street
Dawson Creek, B.C.
V1G 4G2
Ph: 250-782-5251
Fax: 250-784-7563
Long Term
Please submit to Student Services
Campus of Studies Dawson Creek Fort St. John
1. Applicant must notify the College in advance if s/he will not be attending classes as
planned otherwise fees may apply
2. Deposit (application fee plus damage deposit) must be paid to Student Services at
time of application. Payment cannot be remitted by sending credit card information
via FAX. It must be done by phone or in person at Student Services at the campus
where the applicant is attending.
3. To be eligible for a full Damage Deposit refund, Residence stay must be cancelled a
minimum two business days (48 hours) in advance.
4. Applications must be made a minimum of ten (10) business days in advance. Late
registration will incur a $100 surcharge.
5. First and last month’s residence rental fees must be paid to Student
Services on or before the rst day of occupancy.
6. While all efforts will be made to meet individual room requests, NLC reserves the right
to make room assignments according to space availability at the time of application.
7. Potential Long Term Stay occupants are required to reside in the Residence for a
minimum of two months or the length of the program term, whichever is less.
Please PRINT form and sign by hand