GPRC Fairview Campus Student Residence Application

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Basic Information

First Name *

Last Name*

Current Mailing Address *
(Include Postal Code)

Permanent Mailing Address:
(If different from above)

E-mail address

Phone *

Cell Phone

Fax

Gender *

Male
Female

Date of Birth *

GPRC Student ID

Program of Studies *

Program start date *

Emergency Contact Name / Number

Personal Preferences

We receive many more applications than we have housing available. Therefore, it is important for us to know your lifestyle preferences so we can match you with the most compatible roommates possible.

Noise Level *

Quiet - especially during evenings
Regular - regular activity, but evening/night noise is controlled

Alchohol *

Drinking - alchohol permitted in unit
Non-Drinking - alchohol not permitted.

Are you a Smoker? *

Please note smoking or pets are not permitted in any unit at any time.

Yes
No

Accomodation Preference *

Please rank the units below in order of your preference:

Preference	Type of Unit
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice

Preferred Room-mates (and other info):

If there is anybody you would prefer as a room-mate, please list them here. You can also use this to let us know about any special needs you may have or other information which you feel is important for us to know.

Terms and Conditions

Please read the following information carefully before you complete and submit this Residence Application:

The Grande Prairie Regional College Fairview Campus Housing Department requires the collection of personal and other information pursuant to the Colleges Act and the Statistics Act (Canada) for the purposes of Residence administration, including applications, room assignments, roommate notifications, rental agreements, rental assessments and collections, and day-to-day Residence operations including social and activity programming.

The information you provide on this form will be protected under the Freedom of Information and Protection of Privacy Act of Alberta and will be maintained as part of the student record. Certain personal information will be disclosed, by agreement, to the following:

Prospective roommates during the room assignment process
Statistics Canada as required under the Statistics Act (Canada)
Advance Education and Career Development to meet reporting requirements and for statistical, funding, planning or research purposes.

I have read and understand the above and hereby agree to the collection and dissemination of my personal and other information for the purposes stated above.