Residence Application Form

______________________________
My Selkirk College Student Number

I would like accommodation :

Fall Semester ONLYBeginning September 2, and ending December 20, 2013
Fall/Winter Semester Beginning September 2, and ending April 22, 2014
Winter Semester ONLY Beginning January 2 and ending April 22, 2014
Other Beginning:_________/Mo.____________/Day__________/Yr. and ending_________/Mo._________ /Day.________/Yr
Trade Students ONLY

Six Weeks

8 Weeks

10 weeks

12 weeks Course

Program of study at Selkirk_______________________________________________________________ Year

Last Name

First Name

Middle Name

Mailing Address (for refunds and correspondence)

City

Province

E-Mail-student

Phone

Alternate Phone

E-Mail-family

Birthdate:

Postal Code

Fax

Month

Day

Age:

Year

I am:

MALE
FEMALE

I am interested in applying parking a vehicle?

Yes

No

I am a:

Full-time Student
Part-time Student

RESIDENCE PREFERENCE Please rank in order of your preference.

Please note that while we will try and accommodate your preference(s), we cannot guarantee that you will be placed accordingly.
Unit Type
Occupancy
Per Term
Rank
Dorm Unit

$2,000.00

3 Bedroom Pod
5 Bedroom Pod

3
5

$2,000.00
$1,900.00

**Early arrival Fee: Every day before the designated first day of Check-In is CND $22.00

Fall Semester Contract dates Sept. 2-Dec. 20, 2013

Winter Semester Contract dates Jan. 2, 2014-April 22, 2014

UNIT DESCRIPTIONS
Dorm Unit:
one bedroom with desk, microwave and mini fridge; shared washroom, kitchen, and living area
3 Bedroom Pod: bedroom with desk; shared kitchen and living area with pod residents
5 Bedroom Pod: bedroom with desk; shared kitchen and living area with pod residents

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ROOM ASSIGNMENTS
Roomate Request

Please indicate if you have a roommate request.

Name ______________________________________________________________________Address___________________________________________________
Name ______________________________________________________________________Address___________________________________________________
An attempt will be made to place together those students who would like to share a set of rooms.
The answers and information you provide below will be used to assist us in allocating you to a compatible assignment area
that most closely suits your lifestyle preference.
Alcohol Use ;

Do you drink alcohol

Would you prefer your POD/Floor

yes

no

If yes:

Co-Ed

Occasionally

Female Only

Regularly

Male Only

Do you consider yourself :

Very Quiet Unit

Quiet Unit

Do you keep your living space

Tidy

Very Tidy

Social Unit

I give permission to publish my Birthday in the Residence Calendar

Yes

No

Are you a smoker?

Yes

No

Select the one option from each of these categories that best describes you and your habits:
Do you have mobility concerns?
Yes
No
Please briefly describe your mobility concern and the accommodation required:

Tenth Street Residence is a smoke free facility -Smoking is only allowed 25 meters away from the building.
APPLICATION FEE AND ROOM DEPOSIT
Applications will be processed only when accompanied by $130.00 ($30.00 non-refundable application fee and $100.00 room
deposit). Methods of payment (Canadian Funds please) Cheques - Certified cheque/Bank Draft . Visa or MasterCard
Please make cheques payable to SELKIRK COLLEGE.
If you wish to pay the application fee by credit card (Visa or Mast Card), please call the Tenth Street Residence
at 250-505-1393.
REFUNDS
A resident may cancel the rental agreement, in writing (30) days or more prior to the occupancy date and be entitled to the
return of all monies prepaid to Tenth Street Residence in respect of the agreement, with the exception of the $30.00
application Fee.
In making this application I certify that I have read and agree to the terms and conditions on this application, and that all
information that I have provided is correct. Students accepted into Residence who have provided any false information on
their application form may have their License Agreement terminated.
APPLICATION PRIORITIZATION
Applications for residence are accepted from students enrolled at Selkirk College with a 50 % course load. Full-time students
requiring accommodation for the entire academic year are given preference: other students taking less than 50% will need
special permission to stay in residence. All applications are prioritized by application date, permanent home address, and in
accordance with Admissions Policy. References may be requested.
Application does not guarantee assignment.
________________________________________________________________________________________________________________________________

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TENTH STREET RESIDENCE

2013/2014 Payment Schedule
The Tenth Street Residence fees for the 2013/2014 academic year are listed below. If attending regular semester programs,
you may either pay by two installments (see due dates below) or the whole amount.
For all other programs, full payment is required six (6) weeks prior to program start date.
Application Fee (non-refundable) .................................................................................................
Room Deposit ........................................................................................................................................
(applied to fees paid)
Total due upon application submission ...............................................................................
Cleaning Deposit due at time of first installment .....................................................................
(Refundable after resident checks out, less any costs incurred for damage or cleaning)

$ 30
$ 100
$ 130
$ 200

Rental Fee due dates

1st Instalment
...................................................................................... Due July 15, 2013 for Fall Semester
2nd Instalment
.......................................................................... Due November 15 ,2013 Winter Semester
Non-Regular Semester
Full amount at assigned monthly room rate (due six (6) weeks prior to program start date)
I understand that if I become a student in Residence, I must abide by the Rules and Standards of Residence and the
Residence License Agreement.
___________________________________________________________
Date

___________________________________________________________
Signature

___________________________________________________________
Date

___________________________________________________________
Signature (Parent or Guardian if resident is under 18)

NOTE: Selkirk College provides housing to Residents by way of License Agreement only, the Residential
Tenancy Act of BC does not have any application to this agreement.
RETURN THIS COMPLETED FORM TO:
Tenth Street Residence
702 Tenth Street
Nelson, BC V1L 3C7
Ph:250-505-1393 Fax: 250-505-1391
tenthstreetresidence@selkirk.ca

OFFICE USE ONLY

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Date/Time Received: