Application — Newman House

Interested in living at the Newman House? Please fill out the application below and Michaela will be in touch with you shortly regarding your spot for the upcoming school year. Any questions about the contract or application process can be directed to Michaela at michaela.moriarty@undcatholic.org.

Legal Name

First Name

Last Name

Birthdate

YYYY

Year in School

(Upon entering Newman House)

Field of Study

Permanent Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

Please enter a number where we can reach you

(###)

###

####

Email Address

Parent or Guardian

Please include name and relation. This information is in case of emergency

Parent or Guardian Phone

(###)

###

####

When would you like to enter Newman Housing?

Please include semester and year (ex. Fall 2022)

How did you learn about the Newman House?

Select all that apply.

I attended a Women's Night at the Newman House

A friend told me about the Newman House

I heard about it through my bible study

I saw an ad online

My parents told me about the Newman House

My high school told me about the Newman House

I heard about it through the Newman Center

Other reason:

Why would you like to live at the Newman House?

Contract length

Have you ever been convicted of a criminal offense other than a minor traffic violation?

If Yes, Please provide the director (by email) with a statement of a thorough explanation including the date, the county, city and state of conviction, and penalties imposed.

Do you require disability related housing accomodations?

If yes, you will be sent a form to request the appropriate arrangements. Federal law prohibits pre-admission inquiry about disabilities. Information regarding physical or emotional disabilities voluntarily given or inadvertently received will be kept confidential and has no influence on your admission to UND. Newman House is not covered under Title III of the ADA.

Room Preference

Newman anticipates that rooms will be contracted on a double occupancy basis. However, as Newman's sole discretion rooms can be contracted on a single basis. Please check all that apply.

Double

Single

Roommate Requested

Please list one person only. Roommate requests are not guaranteed and must be mutual. Those desiring to room together should apply at the same time and make sure to get contracts and deposits to the house director on time.

referral code (if applicable)

Is there a current Newman House Resident who is referring you to live in the House? If so, put their name below so you can be eligible for the referral discount!

If applicable, please provide the name of your home parish and diocese

I understand that falsifying any information on this application and/or on any subsequent verification submitted in support of this application will result in the cancellation of this application from any waiting list and may also result in referral to the appropriate campus and/or legal authorities. This form is available in an alternate format upon request. St. Thomas Aquinas Newman House reserves the right to make assignments on a temporary basis, as may be needed in an emergency. Assignments are made without regard to race, religion, or origin. Assignment to a room does not mean you have been admitted to the University of North Dakota. I understand that by entering my name in the box below I am signing this document and am therefore held to the above.

Please enter your full legal name in the box below.

Today's date

YYYY