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Algonquin_College_Residence_Online_Application_2011

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					Algonquin College Residence Online Application
Thank you for considering the Algonquin College Residence as your home-away-from-home! We want to make
your time at Residence memorable! Please be sure to complete all the information below to apply for Residence.

If you fill out an email address, a copy of your application will be sent to you. Please keep and print your
application receipt for your reference. The email will be sent from residence@algonquincollege.com. Please
ensure that your email is set to allow emails from this address. Due to over zealous spam filters it is possible you
may not receive a copy of your application email.

NOTE: Submission of application and deposit does not guarantee a bed in Residence.

Request for Residence

     Summer 2011 (May 2011 to August 2011)

     Fall 2011/Winter 2012 (September 2011 to April 2012)

     Winter 2012 (January 2012 to April 2012)

Personal Information
Surname:
First Name:
Initial:
Address 1:
Address 2:
Apt/Unit:
City:
Province/State:
Country:
Postal/Zip Code:
Home Phone Number:
Mobile Number:
Email:
Date of Birth (mm/dd/yy):
Gender:
                                                                 Male
                                                                 Female
                                                                 Transgender

Academic Information
Which Campus you are attending?                                  Woodroffe Campus
Program Name:

Student Status

    First Year Student

    Second Year Student

    Third Year Student

    Fourth Year Student

Resident Status

    New Resident Application

    Returning Resident Application

Further Information
Do you have a disability or illness that requires special accommodations, such as a wheelchair
accessible room or other considerations?

    Yes                                                        No

Do you have a disability, illness or lifestyle preference that the Residence may need to know about to
support your success in Residence?

    Yes                                                        No

Please Note: If you responded yes to either of the two questions above, please complete the “Request
For Special Consideration” form on the website at www.algonquincollege.com

Are you a registered International student?

    Yes                                                        No

How did you hear about Residence?

    Brochure

    Internet

    Friend

    High School

    Other:

Freedom of Information
This collection of personal information is authorized by section 2(2) of the Ontario Colleges of Applied Arts and
Technology Act.. The principal purpose of the collection is to administer this Application and payment or
contractual obligations arising under this Application. It is also to be used for administrative and statistical
purposes of the college and/or the ministries and agencies of the Government of Ontario and the Government of
Canada. Questions about this collection may be directed to the General Manager, Residence Services, 1385
Woodroffe Avenue, Ottawa ON, K2G 1V8, 613-727-7698.


    I have read and agree to the above terms and conditions.

Deposit Payment Information
A deposit of $500.00 is required with your application.

If paying by certified cheque, the cheque must be made payable to "Algonquin College".

Payment Method:

    Credit Card

    Certified Cheque (By Courier)

    Bank Draft (By Courier)

    Money Order (By Courier)

Credit Card Type:

    Visa

    Mastercard

    AMEX

Credit Card Number:
Security Code:
Name that appears on card:
Expiry Date (mm/yy):
Signature
(if submitting this form by mail or fax)

Cancellation Policy
Full cancellation policy is available online at www.algonquincollege.com/residence

				
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