HOUSING/DINING FOR OFFICE USE ONLY:
Date: _______________________ Rec’ by: _______________
AGREEMENT 2011-2012 Check: ________ Cash: _______ MO: _______ Adm: _______
Mail with $200 Prepayment to: Office of University Housing-NKU Assignment Area: ______ Room: __________ Type: ______
Norse Commons 101, Highland Heights, Kentucky 41099 RMS: _____ FC: _____ PDX: _____ Excel: _____WLS: ______
http://housing.nku.edu (866) 572-5676
CONTRACT PERIOD: Academic Year (Fall and Spring) Spring 2012 only (A separate contract is necessary for summer)
1. Name: ______________________________________________________ 2. Birth date: ________________________________________
LAST/SURNAME FIRST MIDDLE
3. Gender: Male Female 4. Social Security #:________/_______/________ 5. Cellular Phone: (_____) ____________________
6. Permanent/Mailing Address: _______________________________________________________________________________________
CITY/STATE ZIP CODE
7. Email Address: _______________________________________________ 8. Home/Alternate Phone: (_____) ___________________
9. Emergency Contact: ___________________________________________ 10. Contact’s Phone: (_____) __________________
11. Do you require accommodations for a disability? Yes No
Please attach specific accommodation needs and documentation from a health care/licensed provider
You must register with Disability Services at (859) 572-6373 in order for accommodations to be considered
12. For the 2011-2012 academic year, I will be a:
New NKU student Returning resident & lived on campus 2010-2011 Current NKU student & did not live on campus 2010-2011
13. For the 2011-2012 academic year, my class status will be: Freshman Sophomore Junior Senior Graduate Law
14. Are you an international student? Yes No If yes, from which country? ____________________________
15. Are you an NKU athlete? Yes No If yes, from which team? _____________________________
16. We will make every effort to accommodate your request for a roommate or room preference; however, assignments are processed in date order that our
office receives your Housing/Dining Agreement (including $200 prepayment) and the space availability of your preferences. Please “” below:
I am aware that my Housing/Dining Agreement is processed in date order and my room type preferences are honored pending space availability.
17. Roommate Preference: Full Name(s)/Phone Number(s) ________________________________________________________________________
It is highly recommended that students requesting specific roommates submit Housing/Dining Agreements & prepayments together.
Please rank the following room types with “1” being your first preference. Please rank at least 8 room type options.
___ Kentucky Hall Double ___ Norse Hall Double ___ Callahan Double/Full Bath/Premium
___ Commonwealth Hall Double ___ Norse/Woodcrest Efficiency ___ Callahan Double/Full Bath/Standard
___ University Suites Double ___ Woodcrest Apts. Double ___ Callahan Double/Half Bath/Premium
___ University Suites Single ___ Woodcrest Apts. Triple ___ Callahan Double/Half Bath/Standard
___ Callahan Quad/Full Bath
18. Living and Learning Communities – OPTIONAL
Students will have the opportunity, on a space permitting basis to participate in a living and learning community. Participation in a living and learning
community requires the student to live on the floor associated with the community. If interested, please rank your preference with #1 being your first choice.
_____ ACCESS (Campus Community Emphasizing Student Success) in Commonwealth Hall– This community is dedicated to providing intentional
opportunities for both male and female first-year students. Prime focuses in programming include Academic Success and Personal Development.
_____ Entrepreneurship Community in Callahan Hall– Offers a living environment for entrepreneurially-inclined students. This experience will enhance a
students’ social and intellectual growth by providing opportunities to learn and interact with each other and with members of the business community
through academic and social events
_____ Honors Residential Community in Callahan Hall – Open to full time undergraduate students who have been invited into the University Honors
Program or are the recipient of an academic related scholarship
_____ Intercultural Living Learning Community in the Woodcrest Apartments- This community offers American and international students the unique
opportunity to live together within an intentional community. Programs and activities will be tailored to meet the diverse needs of the community and to
enrich your cultural experience at NKU. Students interested in studying abroad, learning about different cultures, and supporting international
awareness are encouraged to join and develop lifelong relationships.
_____ NKU ROCKS Learning Community in Callahan Hall- This community is open to students who are enrolled in the NKU ROCKS program through the
Office of African American Student Affairs.
_____ Norse Spirit Community in the University Suites- This new community provides an environment for students who share a passion for school spirit,
history and tradition.
MORE COMMUNITIES LISTED ON PAGE 2
_____ Nursing Community in the University Suites- This community will provide a close-knit community of students. It will focus
on helping students to succeed in their chosen major of nursing. The Department of Nursing works with learning community student advisors to
provide meaningful programs for success. Students must be enrolled in the Nursing or Pre Nursing program to be considered for this community.
_____ Quiet Community in Kentucky Hall- This community enforces 24/7 quiet hours to promote optimal study environment.
_____ Science, Technology, Engineering, and Mathematics Community in Callahan Hall- Open to students with a major in the departments of Biological
Sciences, Chemistry, Computer Science, Mathematics, or Physics and Geology. This experience will enhance a students' social and intellectual
growth by providing opportunities to learn and interact with each other and with members of the STEM community through academic and social events
19. All residents of University Housing are required to have a meal plan (with the exception of Woodcrest Apartments residents). Individuals who
do not select a meal plan (except for Woodcrest Apartments residents) will be assigned the Freedom 2 plus 100 meal plan. It is the responsibility of
residents who are assigned to Woodcrest to cancel one’s meal plan by contacting the Office of University Housing.
Please note: Rates are subject to change by action of the Northern Kentucky University Board of Regents. Adjusted prices will posted at http://housing.nku.edu
Ultimate plus 100 $1490 per semester Housing Plan G (CB Plan 22)
Unlimited meal access in the Village Café. There are no time or frequency restrictions. This meal plan also carries $100 in Dining Flex that can be
used at any retail dining location on campus. Dining Flex has no time or product restrictions. No meal exchange or cash equivalency.
Freedom 2 plus 100 $1360 per semester Housing Plan D (CB Plan 21)
Allows you to redeem up to 2 meals per day (meals reset nightly) at the Village Café for all you care to eat. The $100 in Dining Flex gives you the
added freedom of the extra snack or full meal purchase at any of the retail dining venues. No meal exchange or cash equivalency.
Block Meal Plans:
The 145 Block plus 200 $1425 per semester Housing Plan J (CB Plan 29)
Gives you the ability to use 145 meals at the Village Café during the semester (average of 9 per week). No restrictions or loss of meals on a per week
basis; multiple meals in the same period, no problem. This meal plan comes with $200 in Dining Flex that can be used at any retail dining location on
campus. Dining Flex has no time or product restrictions – you get to decide what and where you eat. No meal exchange or cash equivalency.
The 125 Block plus 275 $1425 per semester Housing Plan H (CB Plan 28)
Gives you the ability to use 125 meals at the Village Café during the semester (average of 8 per week). No restrictions or loss of meals on a per week
basis; multiple meals in the same period, no problem. This meal plan comes with $275 in Dining Flex that can be used at any retail dining location on
campus. Dining Flex has no time or product restrictions– you get to decide what and where you eat. No meal exchange or cash equivalency.
Plan 15 plus 100 $1360 per semester Housing Plan B (CB Plan 2)
Allows you to redeem 15 meals per week (meals reset weekly), one meal per meal period, at the Village Café. This meal plan also carries $100 in
Dining Flex that can be used at any retail dining location on campus. Dining Flex has no time or product restrictions. No meal exchange or cash
20. Have you ever been convicted of a felony or any crime against other persons? Yes No
21. I am aware that NKU’s First Year Student Residency Requirement is listed on the Office of University Housing’s website? Yes
I agree to abide by all rules, regulations, and policies published by Northern Kentucky University as well as the terms and conditions of this Housing/Dining
Agreement. I have read the University policy on alcohol and other drugs as outlined on the websites of the Dean of Students and the Office of University Housing.
I have acknowledged that I have not been convicted of a felony. Failure to abide by this agreement is a cause for action by the Office of University Housing and
Northern Kentucky University.
MY SIGNATURE ACKNOWLEDGES THAT I AM FULLY AWARE THAT THIS HOUSING/DINING AGREEMENT IS FOR THE FULL ACADEMIC YEAR (FALL
& SPRING SEMESTERS) UNLESS I SPECIFY THAT I AM REQUESTING HOUSING FOR THE SPRING SEMESTER ONLY.
Student Signature Date
Parent/Guardian Signature (If student is under 18 years old) Date
THIS CONTRACT WILL NOT BE ACCEPTED AND PROCESSED WITHOUT THE REQUIRED $200 NONREFUNDABLE PREPAYMENT.
THE DEADLINE PENDING SPACE AVAILABITY IS MAY 1, 2011
This publication was prepared by Northern Kentucky University and printed with state funds (KRS 57.375). Northern Kentucky University does not discriminate on the basis of race,
color, national origin, sex, disability, age, religion, marital status, sexual orientation or veteran status in training activities or employment. Educational programs or activities are set forth
in accordance with Title IX, Title VI, ADA and Section 504. For more information, please contact the Office of Legal Affairs & General Counsel, Lucas Administrative Center 824, Nunn
Drive, Highland Heights, KY 41099, (859) 572-5588, which has been designated to coordinate the school’s effort to comply with the aforementioned regulations. 12767
White- Office of University Housing copy Yellow- Student copy