RESIDENCE PROGRAM APPLICATION
The choice to live in the residence program is a decision to participate in a unique community. The residence program provides a context which supports academic achievement, joined to Christian faith and practice. The residence community is based upon principles of self-discipline and mutual accountability. Those who enter residence will be challenged to exhibit concern for others and to call one another to high standards of integrity. All who would pursue such a standard are welcome.
This information is collected under the authority of the Freedom of Information and Protection of Privacy Act. It is required to process the application for a room in the Residence Program at Rocky Mountain College . The information will form part of the student record. If you have any questions about the collection or use of this information, please contact: Residence Program at (403) 284-5100.
Any fields preceeded by an asterisk ( * ) is required.
*Application for:
PERSONAL DATA
Completion of all information is required as part of your application. The information is used to provide a compatible assignment and is confidential. ANY misrepresentation on this application form will deem this application void.
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*First Name: 
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Middle Name: |
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*Last Name:
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Gender:
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* Permanent Address:
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City:
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Province/State:
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Postal Code:
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Country:
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Email:
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* Date of Birth:
(month-day-year)
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ROOM PREFERENCE
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College Manor: |
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Room
preferences cannot be guaranteed, due to high demand.
Stated preferences are assigned on the basis of date of acceptance to
RMC. |
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Have you ever lived in RMC Residence before? Yes No
Details:
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Have you ever been convicted of a criminal offence? Yes No
Reason:
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Have you ever been evicted from any residence? Yes No
Reason:
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What do you expect to gain from living at RMC Residence? |
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Why do you want to live in RMC Residence? |
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How will you contribute to make RMC Residence a positive experience for you, your roommates, the residence staff, and fellow residents? |
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Have you ever lived on your own? Yes No |
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If yes, in which situations? |
In a residence
On your own
With roommates
Other |
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| Please describe briefly any health problems or special needs of which we need to be aware (e.g. allergies, heart condition, diabetes, depression, epilepsy, BPD, etc) and any type of assistance you may require. |
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Do any of these conditions require the use of regular medication? If so please indicate what the condition is and what medications you will need to take. This information will be given to a doctor in the event of an emergency. |
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Have you had or are you now receiving assistance for emotional, mental or chronic physical difficulties (i.e. cutting, eating disorders, borderline personality disorder etc)? |
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If yes, please explain:
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As a member of the Residence Program, I will make the following positive contributions to Residence life:
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Your application for admission to the Rocky Mountain College Residence Program can only be processed with payment of a Residence Reservation & Damage Deposit of $400. The deposit is refundable if a request is received in writing by July 15 for the fall semester and November 15 for the winter semester.
The college accepts VISA and Master Card payments. Please submit now.
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No spaces or dashes in your credit card number please.
To ensure there are no problems processing your donation, please verify the information before submitting.
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*Name on Card:
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Card Type:
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Card Number:
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Expiry Date:
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I have read and understand the philosophy, policies, and procedures that are stated in the Residence Program Handbook. (This handbook can be accessed and downloaded here)
I certify that the particulars furnished are true and complete in all aspects and that no relevant information has been withheld. I have communicated any pre-existing health problems or illness (see Confidential Health Form), so that proper care and attention can be given when necessary.
The Residence Program, in consultation with Student Services, reserves the right to refuse, change of terminate residence accommodation, if it becomes apparent that I withheld any essential medical information, or that a physical, mental or behavioural condition while in Residence, appears to affect the well being of other students.
I understand that Rocky Mountain College reserves the right to cancel any application on medical or any other grounds and agree, if assigned to Rocky Mountain College’s Residence Program, to comply with the Residence Program Agreement and the regulations of Rocky Mountain College.
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Parental Guarantee:
(to be completed if applicant is under 18 years)
I guarantee to pay all charges arising out of the Residence Reservation and Damage Deposit and Contract for the said Applicant.
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