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): ________________________________________ City/Town:______________________________________________________________ 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. Questions: 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? _____________________________________________________________________ Accommodations: 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. _____________________________________ ___________________________________ _____________________________________ Essay: 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…) Agreement: 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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