Summer Application — Newman House

Interested in living at the Newman House this summer? Please fill out the application below and Mary Kaye will be in touch with you shortly regarding your spot for the upcoming summer. 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

(in the upcoming Fall semester)

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

Why do you desire to live at the Newman House for the summer?

Parent or Guardian

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

Parent or Guardian Phone

(###)

###

####

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.

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