* Indicates Required Field
Fall 20 Winter 20
* Name (last, first):
* State, Zip:
* E-Mail address:
* Telephone number:
* Date of Birth (mm/dd/yyyy):
* Anticipated Year at Kuyper College (please check one):
* Cleanliness is important to me:
* Sports/Exercise is important to me:
* My studies are important to me:
* My faith is important to me:
* Involvement on campus is important to me:
* My preferred study environment is:
* I would consider myself to be a:
* I would consider myself to be:
* I would like a roommate who is:
* How involved do you plan to be on campus?
* How involved would you like your roommate to be?
* Do you smoke?
* Would you be willing to room with someone who smokes?
* I like to listen to music:
* How many hours a week do you spend playing video games?
* How many hours a day do you spend on facebook?
* Do you plan on working?
Some of my extracurricular activities include:
I would like to name as my roommate.(They must also indicate the same on their application)
Any additional information (medical conditions/accommodations, allergies, counseling issues, or other things) you feel would be helpful to us in selecting a roommate for you? Please explain and provide pertinent documentation:
* I, agree to pay Kuyper College all current applicable room/board/deposit housing charges. I agree to abide by student regulations and policies published in the Student Handbook and other college statements. I recognize that I am required to live in Campus Housing my first and second years at Kuyper College unless I am 21 years old, have junior or senior status, live with immediate family or have received special permission from the Director of Student Life.
I hereby certify that the facts set forth in this document are true and complete to the best of my knowledge, and I understand that any falsified statements on this document shall be considered sufficient cause for denial or termination of residency.
* Student's Signature:
Parent's / Guardian's Signature (if student is under 18):
Typing your name in the signature space is used to authenticate your identity as the signer of this document.
THIS CONTRACT IS INVALID IF UNSIGNED
This deposit if fully refundable if there are no assessments charged against the deposit during the year and if there are no damages when the student moves out. If a balance is owed to the college by the student when the refund is requested, the deposit will be applied as a credit on the individual's Student Account. This deposit will not be refunded to students who cancel their housing after June 1 for the fall semester or December 26 for the winter semester. Students are responsible for notifying the Resident Life Coordinator if they plan to cancel their room reservations. Students not residing with immediate family must live in campus housing unless they meet the requirements for exemption from the policy.
* Student's financial aid may be reduced by not living in campus housing. Please see the Financial Aid Department for details.
Office Use OnlyAmount: ________________ Check/M.O. Number: ________________ Processed By: ________________
To guarantee your place in housing, your Enrollment Deposit, Housing Deposit and Housing Application must all be on file with the College. Campus Housing will be granted on a space available basis. Please submit your application along with your $200 housing deposit to:Kuyper College Admissions - 3333 East Beltline NE, Grand Rapids, MI 49525. All checks should be made payable to Kuyper College.