St Joseph s College University of Alberta Edmonton Alberta by Larkvorhees


									    St. Joseph’s College, University of Alberta Edmonton, Alberta T6G 2J5 Telephone: (780) 492-7681 FAX: (780) 492-8145

               KATERI HOUSE APPLICATION FORM 2009-2010

Surname:___________________ Given Names:_________________________________
                                                        If you do not use your first name, please circle the one you do use.
Birth Date. D:_____ M:_____Y:________

Home Address: _________________________________________________________

City/Town: ______________________________________________________________

Province:_______ Postal Code:______________

Phone: (         ) -                                   e-mail:__________________________________

Present Address (if different from above): ________________________________________


Province:_______ Postal Code:______________

Phone: (         ) -

Person(s) to Contact in Case of Emergency:
Please indicate relationship to you.

Business Phone: (_____)____ -___________Home Phone: (_____)_____-___________

Address (if different from yours):

Province:___________ Postal Code:____________________

Do you have any medical needs which require special diet or facilities, or which we
should know about? If so, please specify:

Our kitchen is able to cater to most food allergies or other dietary restrictions.
St. Joseph’s College and Kateri House Residences are supportive of all religious faiths.
1. What is your religious affiliation? (for instance, Catholic, Baptist, Sunni Muslim, none …):

2. What is the name of your local church?
If you have no church affiliation, please indicate “none”

3. Name of pastor or local clergy: _________________________________________

4. Please name any members of the Knights of Columbus or Catholic Women’s League among
your family and friends, and specify your relationship:

5. In which Faculty do you plan to study in the coming year? ___________________

6. Which year will you be entering? (Circle one) 1 2 3 4 5 Grad.

7. Has the U of A accepted you yet? _______________________________________

8. If so, do you have your student ID number? _______________________________

9. Please list any scholarships or bursaries which you have received for the coming year:

10. Please name any St. Joseph’s or Kateri House Alumni or Residents among your family and
friends, and specify your relationship:

11. What are your sports, interests, hobbies, instruments, etc.?

12. Are you applying to be in the ACADEMIA Program?

13. How did you learn about St. Joseph’s College and Kateri House?

Our women’s residence is apartment-style; all units are located off a single stairwell in HUB
Mall Residence on the U of A Campus. Our women’s residence consists of 2-bedroom and 4-
bedroom units. We will try to accommodate as many unit requests as possible on a first-come-
first-serve basis, however we cannot guarantee all preferences will be accommodated.
Please state your preference for unit size by checking one (1) of the boxes below.

2-bedroom        4-bedroom        No Preference

For our women’s residence roommate selection is very important. We require that all women
who apply fill out the questionnaire that is part of this application package to help us
match roommates with similar study and recreation habits.
If you have roommate request for the coming year, please note their name(s) and student ID
number(s) below. You can request up to 3 roommates.
_____________________________________             ___________________________________

This section must be completed by the applicant. Successful applicants will be selected largely
on the basis of this section. Please consider each question carefully and answer them on a
separate page.

Why do you wish to stay in Kateri House? (For example, what may we expect in terms of moral
conduct, participation in intramurals and Kateri events, church services, volunteering, etc…)

Please sign the following agreement in the space below:

AGREEMENT: If I am accepted for residence in St. Joseph’s College, and while I am a resident
there, I agree to abide by the Code of Student Behavior of the University of Alberta, and the
rules, regulations and policies of St. Joseph’s College as established by its statutes, by the
President, by the Director of Residence, and by the House Committee. I understand that I am
applying to live in Kateri House for the 8 month academic term September 2008 to April 2009.

Signature: ___________________________________

Date: _____________________

Guardian’s Signature: ______________________________ (if applicant is 17 years old or younger)

Application Deposit:
APPLICATION DEPOSIT: Please enclose a cheque for seven hundred dollars ($700) payable to
St. Joseph’s College.

When the deposit is received, the cheque will be cashed and the application will be reviewed. Cashing the cheque
does not constitute acceptance into residence. If your application is refused, your deposit will be refunded. If you
are on our waiting list, you may request a full refund at any time. If you are on the waiting list, the following
withdrawal deadlines do not apply to you. If you are accepted and you decide to withdraw your application, the
following withdrawal deadlines apply:

Before 1 July = $700 refund (100%)
Between 1 July and 1 August = $350 refund (50%)
After 1 August = No refund (0%).

Signed:____________________________________                          Date:______________________

The personal information collected on this application from is used to maintain college records in
processing your application, monitoring academic standing, providing receipts, distributing follow-up
college-related information, college research, awards, fundraising/alumni contact, and emergency contact.
In signing this form individuals consent to the use of their personal information for these purposes by the
College or as required by the Statistics Act (Canada) or by the Government of Alberta.

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