GUBI’S GATEWAY
2016-2017
1
WELCOME TO LOURDES UNIVERSITY!
Dear Newest Gray Wolf,
Let me be one of many to welcome you, both students and families, into the Lourdes community, and express
how very excited we are that you have chosen to be a Gray Wolf. No matter if you are coming to us directly from
high school, the work place or another college or university, our end goal for you is all the same: success! Student
success is not specific to one major, athletic team, club or organization. Student success is holistic, encompassing
who you are as an individual, how you develop, grow and persist, and how you use your strengths and talents
during your time at Lourdes. I speak for our community when I say how privileged we are to be able to participate
in your future successes.
As an institution, we know that when students begin their first semester with us it is imperative that they
complete and provide us with a number of essential documents before coming to campus and beginning their
academic, athletic and co-curricular careers. It is our desire to have you begin your first semester with all of your
paperwork complete and your Lourdes business finalized. This will allow you to transition smoothly into college
life. We believe so strongly in promoting student success that we have developed the Gubi’s Gateway process to
help ensure a focused start to your college experience.
We would like to introduce you to our Gubi’s Gateway process. Who, or what, is a Gubi you ask? Great question!
Gubbio (Gubi) is the name of our Gray Wolf mascot. The Gray Wolf represents the reverence St. Francis had for all
God’s creatures, including animals and nature. In order for each student to move forward into their first academic
semester at Lourdes, they must pass through Gubi’s Gateway. How do you pass though? By completing and
submitting all the required documents outlined on the following pages. Missing forms and information create
persistent delays for students, and we would like to avoid those hurdles at all costs.
Please complete in full all of the forms housed in this booklet. Please do not tear the forms out. When you
participate in your selected Gray Wolf Registration Day, we will ask that you submit your completed booklet at
that time. You are able to send in your completed booklet prior to your registration day, however we recommend
that you submit it in person. You will also notice on the following page a checklist of requirements, due dates and
Lourdes University contact names and numbers should you have questions when filling out your forms.
Please note, students may not attend the first day of classes or move into the residence halls until all
required documents are completed.
Welcome to Lourdes! We are looking forward to getting to know you. Should you have any questions please do
not hesitate to contact us.
Sincerely,
Rachel Duff Anderson
Dean of Student Life
2
GUBI’S GATEWAY CHECKLIST
Please complete in full all of the forms housed in this booklet. Please do not tear the forms out.
NEEDED DOCUMENTS
DUE DATE
CONTACT FOR QUESTIONS

Enrollment deposit $100.00
May 1, 2016
(or within 3 weeks of acceptance
if admitted after April 15)
Student Accounts 419-824-3695
• REQUIRED

Housing Application or On or before your
Housing Exemption form
Registration Day 2016
• One or the other is REQUIRED, not both

Student Activities Release form
• REQUIRED
On or before your
Registration Day 2016

Health and Immunization form
Andy Ham 419-824-3873
Executive Director of
Residence Life
Ked Desamour 419-517-8992
Student Life Coordinator
On or before your
• REQUIRED
Registration Day 2016
Andy Ham 419-517-8946
Executive Director of
Residence Life

FERPA form
On or before your Registration Day 2016
Registrar’s Office 419-824-3817
By August 1, 2016
Financial Aid 419-824-3732
• STRONGLY RECOMMENDED
• Be sure to read all the information
regarding LUAccess

Complete Financial Aid Process
• STRONGLY RECOMMENDED

Accept Student Aid
•
•
•
By August 1, 2016
REQUIRED
Complete Master Promissory Note
(MPN) and entrance counseling if taking out loans
Submit all information if chosen for verification

Payment Plan Agreement On your Registration Day or
Student Accounts 419-824-3727
by August 1, 2016
Completed and submitted
• REQUIRED
• You will receive this form during your registration day

Final Official Transcript / ACT scores
• REQUIRED
On your Registration Day or
by August 1, 2016
Any Additional Questions:
Rachel Duff Anderson, Dean of Student Life
517-824-3759 • rduff-an@lourdes.edu
3
Admissions office 419-885-5291
LUACCESS
What is LUAccess?
LUAccess provides students the opportunity to identify an individual to serve as a proxy, allowing one to view
specified student information. Students will have complete control over who they assign as a proxy and what
information the proxy is able to see.
The purpose of LUAccess is to provide students with a means to share selected information with a proxy, while still
maintaining the confidentiality of their personal usernames and passwords. LUAccess is an optional service that
students can choose to use (or stop using) at any time.
Through LUAccess, students will be able to grant a proxy permission to view course schedules, term grades,
financial aid packages, billing accounts statements and more. Additionally, students can modify proxy permissions
at any time, set date ranges to limit data access and monitor the activity of proxies through a history log.
Many students, for instance, find it helpful to identify a parent/family as a proxy for billing account statements if it
is the parent who will actually be paying the bill.
Keep in mind that LUAccess does not grant a proxy permission to contact and discuss student information with a
university official. Students will need to complete a FERPA form.
New students can sign up for LUAccess on or after their Registration Date. Visit www.lourdes.edu/LUAccess for
more information on creating an LUAccess account.
4
FERPA FOR FAMILIES
Access to Student Records
The Family Educational Records and Privacy Act of 1974 (FERPA) as amended is a federal law intended to protect
the privacy of student educational records accumulated from early childhood through college. FERPA provides
parents with certain rights with respect to their children’s education records. However, once a student reaches
the age of 18 or enters college, the rights previously held by the parents transfer exclusively to the student.
May I view my child’s grades, exams or academic progress?
Final grades, grades on exams, and other information about academic progress are examples of the confidential
information that makes up part of the student’s educational record. This information is protected under FERPA and
parents do not have access to it unless the student has provided written consent.
But I’m the one paying the tuition! Surely I have a right to see my child’s grades/class schedule/receive the bill!
You have no inherent right to inspect your child’s educational records if he or she refuses to give them to you.
There are 3 ways you may legally receive access to your child’s education records from Lourdes University:
•
Your child may sign a parental release form giving you permission.
•
You provide evidence to the Registrar’s Office that you claimed the student as a financial dependent on your most recent Federal Income Tax form.
•
You obtain a lawfully-issued subpoena or court order.
Ordinarily, parents of Lourdes University students obtain information about their child’s records directly from their
child. FERPA does state that the University may release information to the parents of students but is not required
to do so.
What about crises or emergency situations?
If non-directory information is needed to resolve a crisis or emergency situation, an educational institution may
release that information if the institution determines that the information is necessary to protect the health or
safety of the student or other individuals.
Whom should I contact with questions or concerns?
Direct general questions and send any comments or concerns to the Registrar.
Contact:
Phone: E-mail:
Location: Michelle Rable, Registrar
419-824-3817
mrable@lourdes.edu
Registrar’s Office
Saint Clare Hall 139
5
Lourdes University Registrar’s Office
6832 Convent Blvd., Sylvania, OH 43560
Phone: 419-824-3817 • Fax: 419-824-3962
In compliance with the federal Family Educational Rights and Privacy Act of 1974 and the Regents’ Policy on Access to
and Release of Student Education Records, the University is prohibited from providing certain information from your
student records to a third party, such as information on grades, billing, tuition and fees assessments, financial aid
(including scholarships, grants, work-study, or loan amounts) and other student record information. This restriction
applies, but is not limited to, your parents, your spouse or a sponsor.
You may, at your discretion, grant the University permission to release information about your student records to a third
party by submitting a completed Student Information Release Authorization. You must complete a separate form for
each third party to whom you grant access to information on your student records. The specified information will be
made available only if requested by the authorized third party. The University does not automatically send information
to a third party.
Submit your completed form to Office of the Registrar, Lourdes University, 6832 Convent Blvd., Sylvania, OH 43560 or
fax to (419)824-3762. Please note that your authorization to release information has no expiration date; however, you
may revoke your authorization at any time by sending a written request to the same address. It is University policy not
to release certain aspects of student records (e. g. registration, grades, GPA) over the phone or via email.
A. Student Information
Name (Last, First, M.I.)
Student ID or Social Security No.
Current Address (Street/PO, APT, City, State, Zip)
Telephone No.
B. Third-party Designee
Name (Last, First, M.I.)
Current Address (Street/PO, APT, City, State, Zip)
Relationship to Student
Information types allowed Grades/GPA, demographic, registration, student, ID number, academic progress status, and/or enrollment information. Billing Statements, charges, credits, payments, past due amounts and/or collection activity and Student Accounts transactions.
Financial aid awards, application data, disbursements, eligibility, and/or financial aid satisfactory progress and Financial Aid transactions.
College-maintained loan disbursements, billing and repayment history(including credit reporting history),
communication history, balances, and/or collection activity
Access to student records maintained by the Office of the Registrar, Financial Aid Office and Bursar, including all of the above examples.
C.Certification
Student’s Signature
6
STUDENT LIFE ACTIVITIES WAIVER
LOURDES UNIVERSITY DEPARTMENT OF STUDENT ACTIVITIES AND ORIENTATION PARTICIPATION LIABILITY
RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE
Participant Name:________________________________________________________________________________
Phone #:_______________________________________________________________________________________
LU ID #:________________________________________________________________________________________
Activity/Event: All activities, events, & trips of any kind sponsored by or under the auspices of the
Department of Student Activities and Orientation (the “Activities”)
School Year: August 1, 2016-May 17, 2017
I, being at least 18 years of age, and a student/faculty or staff member of Lourdes University fully
understand and appreciate all dangers, hazards, and risks inherent in participating in the Activities.
Knowing the dangers, hazards, and risks of the Activities, and in consideration of being permitted to participate
in the Activities, on behalf of myself, my family, heirs, and personal representative(s), I, the undersigned, agree
to assume all the risks and responsibilities surrounding my participation in the Activities, the transportation
to and from, and in any independent research or activities undertaken as an adjunct thereto, and in advance
release, waive, forever discharge, and covenant not to sue Lourdes University, its governing board, officers,
agents, employees, and any students acting as employees or volunteers (hereafter called the “Releasees”), from
and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of action, costs,
and expenses of any nature that I may have or that may hereafter accrue to me, arising out of or related to any
loss, damage, or injury, including but not limited to suffering and death, that may be sustained by me or by any
property belonging to me, whether caused by the negligence or carelessness of the Releasees, or otherwise, while
in, on, upon, or in transit to or from the premises where the Activities, or any adjunct to the Activities, occurs or is
being conducted.
I understand and agree that Releasees will not have medical personnel available during the Activities. I understand
and agree that Releasees are granted permission to authorize emergency medical treatment, if necessary, and that
such action by Releasees shall be subject to the terms of this agreement. I understand and agree that Releasees
assume no responsibility for any injury or damage which might arise out of or in connection with such authorized
emergency medical treatment. I further agree that I am fully responsible for any payments of incurred medical
expenses as a result of participating in the Activities.
It is my express intent that this release and hold harmless agreement shall bind the members of my family, if I am
alive, and my estate, family, heirs, administrators, personal representatives, or assigns, if I am deceased, and shall
be deemed as a release, waiver, discharge and covenant not to sue the above-described Releasees. I further agree
to save and hold harmless, indemnify, and defend Releasees from any claim by me or my family, arising out of my
participation in the Activities.
7
In signing this Release, I acknowledge and represent that I have fully informed myself of the content of the
foregoing waiver of liability and hold harmless agreement by reading it before I sign it, and I understand that I
sign this document as my own free act and deed; no oral representations, statements, or inducements, apart from
the foregoing written statement, have been made. I understand that Lourdes University does not require me to
participate in the Activities, but I want to do so, despite the possible dangers and risks and despite this Release. I
further state that I am at least eighteen (18) years of age and fully competent to sign this agreement. I further state
that there are no health-related reasons or problems which preclude or restrict my participation in the Activities.
I have adequate health insurance necessary to provide for and pay any medical costs that may be attendant as a
result of sickness or injury to me and that Releasees shall have no responsibility for the payment of same.
I further agree that this release shall be construed in accordance with the laws of the State of Ohio. If any term or
provision of this release shall be held illegal, unenforceable, or in conflict with any law governing this release, the
validity of the remaining portions shall not be affected thereby.
I agree that my signature denotes my affirmation that I will abide by all state, local and federal laws as well as the
Lourdes Student Code of Conduct.
THIS IS A RELEASE OF LEGAL RIGHTS. READ ABOVE AND BE CERTAIN YOU UNDERSTAND IT BEFORE
SIGNING.
Participant Signature and Date
(Print) Participant Name
For Minors Only:
Parent/Guardian Signature and Date
(Print) Parent/Guardian Name
Emergency Contact Information
I realize that participation in the Activities, both on and off campus, involves risks. In the event of an emergency,
the person/s named below is authorized to act on my behalf in the event that I am incapacitated. In the event the
person named below cannot be reached, I authorize Lourdes University faculty and/or staff to arrange emergency
medical treatment on my behalf.
Name of Emergency Contact
Relationship to Emergency Contact
8
Emergency Contact Phone
This box for office use only.
Student ID:
LOURDES COMMONS HOUSING APPLICATION
2016-2017 ACADEMIC YEAR
FALL 2016 CLASS STANDING:
1st YEAR
SO
JR SR
GRAD
TRANSFER
Name: ____________________________________________________ Gender: Female Male
Home Address: ____________________________________________ Student Cell:_______________________
City/State/Zip: _____________________________________________ Home Phone:_______________________
Student Email: _____________________________________________ Birthdate: _________________________
*Mother/Father/Guardian Name:______________________________ Are you a student athlete? Y N
*Mother/Father/Guardian Phone: ______________________________ If so, what sport?____________________
*For emergency notification only.
Have you been awarded an athletic scholarship? Y N
Have you applied for Honors/Deans Scholars program? Y N
*Price Per Semester Per Student
Housing

1 bedroom 1 student...............................................$3,700
 1 bedroom 2 students.............................................$2,500
 2 bedroom 2 students in master.........................$2,500

2 bedroom 1 student in small room..................$3,100
Meal Plan Rate
 19 meal with $100 spending................................$2,200
 15 meal with $50 spending...................................$2,100
 10 meal with $50 spending...................................$1,900
All undergraduate traditional students must purchase a
meal plan.
Graduate & Non-traditional Student 12 month
leases
 1 bedroom single......................................................... $580
 1 bedroom married .................................................... $630
 Furniture rental................................................................$55
All first year students will automatically be assigned the
19 meal plan.
The Residence Halls will be closed from the end of the Fall
term until the day before classes start for the Spring term.
The halls will also be closed during Thanksgiving and
Spring Breaks. All students are expected to leave during the
times the halls are closed.
*Prices may change for 2016-17 school year.
No single 1 bedroom units will be assigned to incoming
first year students.
If you would like to request a specific roommate, please print that person’s complete name in this box.
If you have a documented disability and require special housing accommodations,
please contact the Accessibility Services Office by e-mail at oas@lourdes.edu or call 419-824-3523.
9
It is the policy of Lourdes University that all students who have not reached the age of 18 by the day they move
into a Lourdes residence facility have a parent or guardian sign their housing application. By signing the housing
application, the parent or guardian is acknowledging that they can be held liable for the behavior of their
underage dependent until the student reaches 18 years of age. This includes damage to the residential facilities as
well as other school property.
Lourdes has a priority deadline of May 1 for the Fall semester. Late applications may be considered in the order in
which they were received if beds are still available. Please submit this completed and signed form along with the
housing deposit to:
Lourdes University Residence Life
6832 Convent Blvd., Sylvania, OH 43560
PLEASE READ CAREFULLY:
This form does not guarantee that all of your preferences/requests will be granted. This form is for the Residence
Life Staff to best match you up with someone who shares common interests, values or a similar schedule.
Lourdes reserves the right to make any and all final housing and roommate assignments during the year for the
good of the resident, the residential community, or any other reason deemed appropriate by Lourdes. It is in
your best interest to answer these questions as honestly as possible.
Circle one response for each question and then indicate roommate preference.
I prefer that my roommate is:
Same Opposite Neutral
1. I am a: Non-smoker












5. I would describe myself as: very neat usually neat not concerned about neatness



6. For studying, do you prefer: quiet
moderately noisy noisy



2-3 hours 4 or more hours 


8. I am most comfortable:with large groups with a few close friends alone in my room  

9. If you are over the age of 21, do you consume alcohol? Yes


Smoker
An occasional smoker
Smoking is not permitted in any campus building including student housing.
2. I go to bed at: 10 - 11p.m.
12 - 1 a.m.
2 a.m. or later
3. I am more active in: The morning
The evening 4. I would describe myself as: very quiet
fairly quiet
moderately quiet
7. I believe that I will study each day: 1 hour or less
doesn’t matter social
very social No 10.What types of TV/Movies do you enjoy? (circle all that apply)
Comedy Drama Horror Science Fiction Cartoons Crime/Mystery
11.What types of music do you enjoy? (circle all that apply)
Alternative Classic Rock Country Jazz/R & B Classical
Hard Rock/Metal Pop/Top 40

O
ther:_________________
Dance/Hip Hop/Rap
12.What is your intended major for the 2016-17 school year?_______________________________________
10
I understand that acceptance of this application does not constitute a guarantee of assignment to a residential
apartment nor admission to the University. Also, I have read and understand the terms of this application as
stated herein.
By signing below, I agree to abide by the policies in the Lourdes University Student and Residential
Handbooks. The Lourdes University Student and Residential Handbooks can be found on the Lourdes
University web site.
Your information will remain confidential, to the extent possible, with the exception of the student’s name,
address, e-mail.
An address and telephone number will be disclosed to the assigned roommate unless the student requests
otherwise.
Student’s Signature:________________________________________________________Date:_____________
Parent or Guardian’s Signature:_______________________________________________Date:_____________
(Parent/Guardian’s signature is needed if student will not reach 18 years of age by the date they move into a Lourdes University residential
facility)
11
RESIDENCY REQUIREMENT FORM
All Lourdes University Students are required to live on campus for eight semesters unless the student
meets one of the following exceptions:

Lives with a parent or guardian within 35 miles of campus. Please visit www.lourdes.edu/housing and click on the residency requirement for a list of zip codes which fall within 35 miles of Lourdes University

Has reached the age of 23 prior to the beginning of the fall semester

Is married or has a child

Is serving or has served in the U.S. Armed Services

Has received an exemption from the Office of Accessibility Services based upon an accessibility issue
If one or more of the above exceptions applies to you, please check the appropriate box and sign below. If you do
not meet one of the above exceptions you will be required to live at Lourdes University in on-campus housing.
If living with a parent or guardian within 35 miles of Lourdes University, please list current address below.
Street City State Print Full Name
Signature Date
Parent Signature Date
12
Zip
A MESSAGE FROM FINANCIAL AID
So you know the degree you want and you know the classes you need to take, but do you know how you will
pay for it all? At Lourdes FAO we have trained staff to assist you in the financial aid process. If you have not filed a
FAFSA (Free Application for Federal Student Aid) simply follow the steps below!
To qualify for financial aid just file your FAFSA!
1. Get an FSA ID at https://fsaid.ed.gov/npas/index.htm
2. Fill out the FAFSA at www.fafsa.gov
3. Add Lourdes school code: 003069 to your FAFSA
• Already filed your FAFSA and need to add Lourdes school code? Just go to www.fafsa.gov, log in, and click
on Add/delete school code. Then add 003069.
• Don’t think you should bother to file a FAFSA? Students, and their parents, usually state the reason they did
not file the FAFSA was because they knew they would not be eligible for federal aid. But just so you know, no
matter what your family income and assets are, you are still eligible for a low interest federal student loans.
If you would like to be considered for a federal student loan, or if your parent would like to borrow the low
interest Parent PLUS loan, you should file your FAFSA soon! We strongly recommend it!
* See page 15 for a financial aid checklist! *
13
FINANCIAL AID CHECKLIST
The following is a general financial aid checklist that can be used to help you keep track of the financial aid
process.

Investigate private sources of financial aid for college. Check with your school, local library, local businesses and civic organizations, and your or your parents’ employer(s).
Take advantage of free Internet scholarship search engines, such as:
• FinAid on the Web – www.finaid.org
• FastWeb – www.fastweb.com
• Schoolsoup – www.schoolsoup.com
• Scholarship – www.gocollege.com

Obtain a Federal Student Aid Identification (FSA ID) for use throughout the federal aid process during and after college from the U.S. Department of Education website at https://fsaid.ed.gov/npas/index.htm. You’ll need one to sign your FAFSA!

File your Free Application for Federal Student Aid (FAFSA) as soon as possible. File the FAFSA electronically online at www.fafsa.gov. Be sure to add Lourdes school code, 003069. You can add up to ten schools.

After you file your FAFSA, you will receive your Student Aid Report (SAR) from the U.S. Department of Education. It will be sent to you via e-mail or postal mail after you file the FAFSA. Review the SAR for accuracy. If corrections are needed, correct online at www.fafsa.gov.

Promptly respond to any requests from your financial aid office for additional information or documentation, such as federal tax return transcripts, verification worksheets, or other forms. Delays will slow down your financial aid process.

Promptly sign and return your financial aid award letter to accept the aid being offered. Contact our financial aid office if you have any questions about your award.

For federal student loans, you must complete the entrance counseling and promissory note for any federal loan(s) you are offered and wish to accept. Before completing, make sure you read and understand all of your rights and responsibilities. You can complete these requirements online at www.studentloans.gov.

If you have been awarded Federal Work-Study (FWS) assistance, find out how students are placed in FWS positions and what FWS positions are available, including descriptions of job responsibilities and wages. Visit http://www.lourdes.edu/costs-financial-aid/financial-aid/types-of-aid/federal-work-studyprogram for more information on this program.
*** This is not a complete list of financial aid requirements. Be sure to always check with the Lourdes financial aid
office to make sure you complete all of the necessary requirements.
14
STUDENT ACCOUNTS LETTER
Welcome to Lourdes University. We hope you will enjoy being a part of our community. We want to make paying
for your education an affordable investment that works with your and your family’s budget.
Once you have reviewed your financial aid offer, you may find that you still may owe money to Lourdes. Filling out
a Payment Plan agreement will help you discover how best to handle any balance due. You have several options
available to you.
• Pay any balance after financial aid in full prior to the beginning of the semester.
• Pay the balance after financial aid due in 10 equal installments on the 20th of each month beginning in July and ending in April for the academic year.
• Let us know that financial aid will cover the entire balance. This may include applying for a Parent PLUS loan.
You will find a sample Payment Plan Agreement in this booklet for your review. We will provide a personalized
agreement form on your Registration Day for you to sign and return to us.
The following Payment Options are offered:
• We accept cash, personal check, MasterCard, Visa, American Express, and Discover.(Credit card payments are subject to a 2.5% convenience fee per transaction.)
• Online payment is available for credit or web check payments. (Credit cards are subject to the same fee above; web checks are subject to a flat $3 per transaction fee.)
You can pay in-person at the Cashier’s Office or by mailing a check to the following address:
Lourdes University, Cashier’s Office
6832 Convent Blvd., Sylvania, OH 43560
When you register for classes, you will receive a paper Schedule Bill with your current term charges. After that,
students will receive email reminders of balances due through their Lourdes University email account. If you prefer
to have a paper bill sent to the student’s home address, please contact the Student Accounts Office at
419-824-3727.
Please review the enclosed Payment Plan Agreement form for the 2016-2017 year for Lourdes University. To set up
your payment arrangement, please complete the form and return it to the Student Accounts Office prior to the
start of the semester.
The payment plan option divides the balance of each semester into 5 equal payments. When completing this
form, remember that there are fees associated with the Direct Loans that may alter the balance. If you would like
help calculating these fees, please feel free to contact the Student Accounts Office by email (studentaccounts@
lourdes.edu), by phone (419-824-3727), or stop into the office during business hours (Monday through Thursday
9 a.m. - 5:30 p.m., and Friday 8 a.m. - 4:30 p.m.).
Please note that you may not be able to register for future terms or see your grades is payments are not made
when due.
If you need to reprint the Payment Plan Agreement form, you may do so by going to:
http://www.lourdes.edu/wp-content/uploads/2015/12/PaymentPlanAgreement.pdf
If you have questions about your bill or completing the Payment Plan Agreement form, please contact the Student
Accounts Office. Lourdes University at: studentaccounts@lourdes.edu or 419-824-3727 (phone) or 419-517-8921
(fax).
15
STUDENT TEST PAYMENT PLAN
February 9, 2016
John Smith
6832 Convent Blvd
Sylvania, OH 43560
ESTIMATED CHARGES
Student ID: 90000000
Summer 2016
Fall 2016
Tuition
Fees
Spring 2017
9,960.00
350.00
TOTAL
9,960.00$19,920.00
350.00
$700.00
Housing 2,500.00 2,500.00$5,000.00
Meal Plan
2,200.00
2,200.00
$4,400.00
TOTALS
15,010.00
15,010.00
$30,020.00
AWARDS
Summer 2016
Fall 2016
Spring 2017
TOTAL
Lourdes Presidential Scholar
3,500.00
3,500.00
$7,000.00
Wolf Grant
675.00
675.00
$1,350.00
Scholars Housing Award
500.00
500.00
$1,000.00
Pell Grant
1,663.00
1,662.00
$3,325.00
University Grant
1,000.00
1,000.00
$2,000.00
Direct Loan Subsidized
1,750.00
1,750.00
$3,500.00
Direct Loan Unsubsidized
1,000.00
1,000.00
$2,000.00
TOTALS$10,088.00$10,088.00$20,175.00
2016-2017 ESTIMATED CHARGES AND AWARD SUMMARY
Total Estimated Charges
$30,020.00
Total Student Aid -$20,175.00
Your Financial Responsibility* $9,845.00
*Without PLUS
** New students may have an additional Orientation fee not listed above. Additional course fees, such as lab
fees, are not included. Actual loan amounts paid are less federal loan origination fees: 1.068% for Federal Direct
Student Loan, 4.272% for Federal PLUS Loans.
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PAYMENT OPTIONS
Please Choose One:

Option 1: I will pay the full balance due above by August 1 for Fall semester and January 2 for Spring.

Option 2: I will pay the balance due in 10 equal monthly payments of $________due on the 20th of each month b
eginning in July with the final payment for the academic year due in April.

Option 3: My financial aid will cover my balance.

Option 4: I am unsure but will submit this form by August 20th 2016.
TERMS and CONDITIONS
• Lourdes reserves the right to forward past due accounts to a collection agency. I agree to pay all collection costs, including attorney’s fees, if I fail to pay this debt prior to the end of the academic year.
• Any past due balance may prevent registration for the future semester(s) and access to grades and transcripts.
I have read and agree to the above terms and conditions. I understand any changes to the above estimates may
require adjusting the monthly payment amount.
Student Name (Print)
Student Signature
Student ID# Date
Parent or Guardian signature (if dependent)
Lourdes Representative Submit this worksheet to Lourdes Student Accounts Office
6832 Convent Blvd. Sylvania, Ohio 43560
For questions, please contact
Phone: 419-824-3727
Email: studentaccounts@lourdes.edu
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HEALTH HISTORY CONSENT AND RELEASE FORM
Please print this form, complete it and return the completed form on your registration date.
Lourdes University maintains health records on all students in order to help medical professionals facilitate proper
health care in the event of an emergency. It is essential to have background medical history information and
immunization records on new students. To assist us in this process, we ask all new students to complete a Health
History Form/Immunization Record. The completed form as well as the Consent and Release form below should
be returned with your Housing Contract.
Consent and Release
I certify that I understand the contents of this form, and that my signature represents a free and voluntary act
of consent thereto on behalf of the student named below. I further certify that I expect my specific information
regarding service from Lourdes University will not be released with out the express written consent of the Student
unless disclosure is mandated by law or in the professional judgment of the Dean of Students or Director of
Residence Life is necessary to protect the physical safety of the student or community at large.
I hereby authorize any health care facility or health care provider to furnish the Dean of Students, Director of
Counseling or the Director of Residence Life medical records and information pertaining to the medical history,
mental or physical condition, services rendered, or treatment of the patient named below. This authorization
should remain in effect until revoked in writing, or if the student graduates/withdraws from the University. A
photocopy of this authorization shall be deemed as valid as the original.
In case of illness or accident deemed serious by Lourdes University, I authorize said persons to notify the parent or
guardian named on this form, and the Dean of Students if I am unable to do so.
Signature of Student Date
Signature of Parent/Guardian (if student is under 18 years of age) 19
Date
Name _____________________________________________ SS# ___________________________ Date of Birth __/__/ __
Last First M.l.
Entering Lourdes University as a:  Freshman  Transfer  Grad Student
 Summer 20__
_
 Fall 20__  Spring 20__
Personal History (PLEASE PRINT)
Name ____________________________________________________________________________
Last First M.l.
HAVE YOU HAD? (mark choice)
Yes
HAVE YOU HAD? (mark choice)
No
Recurrent Headache
Epilepsy
Eye Problems
Seizures
Ear Problem
Dizziness
Nose problem
Fainting with Exercise
Throat Problem
Head Injury
Thyroid Problem
Concussion
Heart Murmur
Bone Injuries
Heart Disease
Joint Injuries
Heart Palpitations
Stomach Injuries
High Blood Pressure
Intestinal Problems
Low Blood Pressure
Diabetes
Anemia
Eating Disorder
Sickle Cell
ADD
Bleeding Disorders: Hemophilia/Other
ADHD
Hepatitis
Chicken Pox Vaccine
Kidney Disorders
Chicken Pox Illness
Bladder Disorders
Mononucleosis
Pneumonia
Alcohol Abuse
Bronchitis
Drug Abuse
Tuberculosis
Sexual Abuse
Seasonal Allergies/Hay Fever
Victim of Violence
Asthma
Emotional Problems-Specify below:
Surgeries:
Hospitalizations:
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Yes
No
List any medications that you are allergic to?_________________________________________________________________
List any allergies to food, latex, herbal and over-the-counter medications?_________________________________________
List any other allergies?__________________________________________________________________________________
List any medication you are currently taking?________________________________________________________________
Any other disease, illness, past surgeries, permanent disabilities or concerns?______________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Are you currently being treated by a health care professional? If yes, explain_______________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Date
Please Print or Type
Social Security # (Last 4 digits)
Student Last Name, First Name, MI
Address
City
Telephone
Cell Phone
State
Date of Birth
Zip
Age Gender
 Male
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 Female
Emergency Contacts
Parents/persons to be contacted in case of emergency
Please list two contacts.
1.Name
Relationship
Home Phone
Address
Indicate Cell or Work Phone
2.Name
Home Phone
Relationship
Address
City
Telephone
Indicate Cell or Work Phone
State
Cell Phone
Date of Birth
Zip
Age
Gender
Primary Care Physician
AddressPhone
Fax
INSURANCE INFORMATION
Complete data below and attach copies of both sides of your insurance and prescription cards.
Insurance Co. Name
Member Benefits Phone Number
Address (to send to claims)
City
State
I.D. #
Zip
Group #
Insured’s Name
Insured’s SS#
Insured’s Date of Birth
Relationship to Insured
(Policy holder/Responsible party) Child  Spouse  Other
Prescription Card Name
Telephone
Cell Phone
Spouse # Card Member #
Date of Birth
Age
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Customer Service Phone #
Gender
VACCINATION POLICY
Lourdes University does not require immunizations for admittance to the University. The University strongly
recommends that you receive all of the following immunizations:
• Measles, Mumps, Rubella (MMR): Two doses of MMR at least 28 days apart after 12 months of age
• Tetanus, Diphtheria, Pertussis (DT, TdaP, DTP, or TD): Booster dose within the past 10 years
• Hepatitis B: Series of 3 doses (Students participating in programs related to health, education, or studying abroad, may be required to be immunized against Hepatitis A and B)
• Meningitis Vaccine (Menactra): University populations are considered at increased risk, including students living in residence halls
Policy regarding student Meningitis and Hepatitis B
Ohio Revised Code Section 3345.85 for institutions of higher education requires that the institution maintain
individual status records on meningococcal meningitis and Hepatitis B vaccinations for student living in oncampus housing. The Lourdes University Residence Hall Contract contains a section asking for the vaccination
status of a student who will be living in a residence hall. A housing contract will not be accepted if this
information is not completed.
The Ohio Revised Coded (ORC) Section 1713.55 states that beginning with the academic year that commences on
or after July 1, 2005, an institution of higher education shall not permit a student to reside in on-campus housing
unless the student (or parent if the student is younger than 18 years of age) discloses whether the student has
been vaccinated against meningococcal disease and hepatitis B by submitting a meningitis and hepatitis B
vaccination status statement.
ORC Section 3701.133 states that the Ohio Department of Health (ODH) shall make available on its Web site
information about meningitis and hepatitis B, the risks associated with the diseases and the availability and
effectiveness of the vaccines. ODH shall also make available, on its Web site, in a format suitable for downloading,
a meningitis and hepatitis B vaccination status statement form that complies with the guidelines outlined in ORC
Section 3701.133, (B).
On this page you will find an information sheet on each disease (i.e. meningococcal meningitis and hepatitis B
infection) and a vaccine status statement that may be downloaded, printed and used if the institution of higher
education chooses. The institution may also develop its own form, but any form must comply with ORC Section
3701.133, (B). Please note that this law does not require vaccination of the student, nor does it require the
institution to provide or pay for these vaccines. It requires only disclosure of vaccine status of the student.
MENINGOCOCCAL DISEASE AND UNIVERSITY STUDENTS
Meningococcal disease is a serious illness caused by bacteria. It is the leading cause of bacterial meningitis in
children 2-18 years of age in the United States. Meningococcal bacteria can cause meningitis (inflammation of the
lining of the brain and spinal cord) or sepsis (an infection of the bloodstream). Symptoms of meningitis include
stiff neck, headache, fever, nausea, vomiting, confusion and drowsiness. Symptoms of sepsis include fever, shock
and coma. Death from sepsis can occur within 12 hours of the beginning of the illness – meningococcal disease
can be a rapid and overwhelming infectious disease. For these reasons, meningococcal infections that occur in
childcare centers, elementary schools, high schools and Universities often cause panic in the community. Every
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year about 2,600 people in the United States are infected with meningococcus. Ten to fifteen percent of these
people die, in spite of treatment with antibiotics. Of those who live, another ten percent lose their arms or legs,
become deaf, have problems with their nervous systems, become mentally retarded or suffer seizures or strokes.
How do you catch a meningococcal infection?
Usually meningococcal infection is acquired after intimate contact with an infected person. Intimate contact
includes kissing, sharing toothbrushes or eating utensils or frequently eating or sleeping in the same dwelling as
an infected individual.
Who is at risk?
Anyone can get meningococcal disease, but it is most common in infants less than 1 year of age and in people
with certain medical conditions. University first year students, particularly those who live in dormitories, have
a slightly increased risk of getting meningococcal disease. The risk for meningococcal disease among non-first
year University students is similar to that for the general population; however, the vaccine is safe and effective
and therefore can be provided to non-first year undergraduates who want to reduce their risk for meningococcal
disease.
What can be done to decrease risk?
The meningococcal vaccine can prevent four types of meningococcal disease. These include two of the three
most common types in the United States. Meningococcal vaccine cannot prevent all types of the disease, but it
does help to protect people who might become sick if they don’t get the vaccine. The vaccine is available through
a variety of settings including physician offices and university/college student health centers.
What about the vaccine?
A vaccine, like any other medicine, is capable of causing serious problems, such as allergic reactions. People
should not get meningococcal vaccine if they have ever had a serious allergic reaction to a previous dose of
the vaccine. Some people who get the vaccine may develop redness or pain where the shot was given, and a
small percentage of people develop a fever. These symptoms usually last for one or two days. The risk of the
meningococcal vaccine causing serious harm is extremely small. Getting meningococcal vaccine is safer than
getting the disease. People who are mildly ill at the time the shot is scheduled and women who are pregnant can
still get the vaccine. Those with moderate or severe illnesses should usually wait until they recover. University
students and their parents should discuss the timing, risks and benefits of vaccination with their health care
providers. For more information about the meningococcal vaccine access the Vaccine Information Sheet at the
Centers for Disease Control and Prevention (CDC) Web site http://www.cdc.gov/nip/publications/VIS.
If University students decide to be vaccinated against meningococcal meningitis, they (or their parents if they are
less than 18 years of age) should contact their health care provider or the university/college student health center
where they will be attending to inquire about receiving the vaccine. Although the need for revaccination with the
current polysaccharide vaccine has not been determined, antibody levels rapidly decline in two to three years, and
if indications still exist for vaccination, revaccination may be considered three to five years after receipt of the first
dose. In February 2005 the Advisory Committee on Immunization Practices (ACIP) to the CDC recommended the
use of a newly licensed conjugate meningococcal vaccine for vaccination against meningococcal meningitis. The
new vaccine was licensed by the U.S. Food and Drug Administration in January 2005 for use in people 11-55 years
of age. This conjugate meningococcal vaccine is effective in preventing the same four types of meningococcal
disease as the polysaccharide meningococcal vaccine. Although the need for revaccination with the conjugate
meningococcal vaccine has not been determined, antibody levels decline in 6-8 years and if indications still exist
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for vaccination, revaccination may be considered 6-8 years after receipt of the first dose.
Adapted from CDC publications.
HEPATITIS B AND UNIVERSITY STUDENTS
Hepatitis B is a virus that affects the liver. It is one of several hepatitis diseases (for example, hepatitis A and
hepatitis C) that are caused by different viruses but are similar in that they all attack the liver. The hepatitis B
virus (HBV) can cause a short-term (acute) illness that leads to loss of appetite, stomach pain, tiredness, diarrhea,
vomiting, jaundice (yellow skin or eyes) and pain in muscles and joints. These symptoms can last for several
weeks. It can also cause a long-term (chronic) illness from which people never recover. A person might not look
or feel sick, but he or she carries the hepatitis B virus in their blood for the rest of their lives and can infect other
people with HBV. Chronic hepatitis B may cause liver damage (cirrhosis), liver cancer and even death. About 1.25
million people in the United States have chronic HBV infection. Each year 80,000 more people, mostly young
adults, get infected with HBV and 4,000 to 5,000 people die from chronic hepatitis B.
How do you catch Hepatitis B?
HBV virus is spread through contact with blood or other body fluids of an infected person. You can catch the virus
by having unprotected sex, by sharing drug needles or by sharing personal items such as razors and toothbrushes
with someone who is infected. Babies of chronic HBV mothers can become infected during birth. Children can be
infected through exposure to blood and other body fluids from infected children or adults.
Who is at risk?
Anyone who participates in any of the behaviors listed above is at risk of acquiring hepatitis B.
What can be done?
There are hepatitis B vaccines available that can prevent infection with HBV. Many physicians offer the vaccine
to patients seen in their offices. These are the first anti-cancer vaccines, because they can prevent a form of liver
cancer that can develop in a person who gets a chronic hepatitis B infection.
What about the vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as allergic reactions. Most people who
get hepatitis B vaccine do not have any problems with it. People who have ever had a life-threatening allergic
reaction to baker’s yeast (the kind used to make bread) or to a previous dose of hepatitis B vaccine should not get
the vaccine. People who are moderately to severely ill at the time the shot is scheduled should usually wait until
they recover before getting the vaccine. Hepatitis B vaccine is very safe and the risk of it causing serious harm is
extremely small. Hepatitis is a serious disease and getting the vaccine is safer than getting the disease. University
students and their parents should discuss the risks and the benefits of vaccination with their health care providers.
For more information about the hepatitis vaccine, access the Vaccine Information Sheet at the Centers for Disease
Control and Prevention Web site http://www.cdc.gov/nip/publications/VIS. If University students decide to be
vaccinated against hepatitis B, they (or their parents if they are less than 18 years of age) should contact their
health care provider or the university/college student health center where they will be attending to inquire about
receiving the vaccine.
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MENINGOCOCCAL AND HEPATITIS B VACCINATION STATUS FORM
Please print this form, complete it and return the completed form on your registration date.
Adapted from CDC publications.
Name of Student: ________________________Date of Birth: _____/_____/_____
I, the undersigned student (if 18 years of age or older) or parent (if student is under 18), have read and
understand the information provided to me about Meningococcal Meningitis and Hepatitis B. I understand
the benefits and risks of being vaccinated against these diseases. The information below regarding my own/my
student’s vaccination status is accurate and is being provided in compliance with the Ohio Revised Code,
Section 3701.133, (B).
Meningococcal vaccine received: Yes _______________ No ______________
If yes, please list the date: _____/_____/_____
Hepatitis B vaccine received: Yes _______________ No ______________
If yes, please list the dates: 1st Dose _____/_____/_____
2nd Dose ______/_____/____
3rd Dose _____/_____/_____
Date: ______/______/______
Signature (Student /Parent)
______________________________________________________
Address of Student
_______________________________________________________
_______________________________________________________
_______________________________________________________
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32 Black Locust Crucifix
33 Canticle of Praise Prayer Garden
34 Statue of Our Lady of Sylvania
35 Statue of St. Francis and Animals
36 Statue of St. Francis and Wolf of Gubbio
37 Commemoration of the Unborn
20 All Good Things
21 Maria Hall
22 Portiuncula Chapel
23 Our Lady Queen of Peace Chapel
24 Year Round Garden
25 Regina Hall
• Institutional Advancement (IA)
• Sylvania Franciscan Village Office
26 Umbria Hall
28 Canticle Center
• Sophia Counseling Services
Satellite Office
27 Facilities and Grounds
38 Grotto of Our Lady of Lourdes
Shrines
19 Madonna Hall
18 Hermitages
29 Rosary Care Center
30 Sophia Center
31 Our Lady of Grace
Sylvania Franciscan Ministries
41 Mid-campus
• Future site of Russell J. Ebeid
Recreation Center
• Lacrosse and soccer practice fields
• Spirit rock and firepit
39 Public Safety
40 San Damiano Campus Ministry House
30 Sophia Center
25 Regina Hall
• Lourdes Institutional Advancement (IA)
28 Canticle Center
• Art & Music Classrooms
• Graduate School
• Sophia Counseling Services
Satellite Office
14 The Den (Sylvan Square)
• Health Center
• The Rec Room
• Coaches Offices - basketball, cheer,
cross country, golf and lacrosse
13 Lourdes University Bookstore
12 Lourdes Commons
a - Ambrose Hall
b - Bonaventure Hall
c - Justinian Hall
d - Pioneer Hall
e - Rosaria Hall
f - Emmanuel Hall
11 St. Joseph Hall (SJH)
• The Flasck Nursing Center
17 Porta Coeli Cemetery
16 Alverno Studio
Sisters of St. Francis Buildings
10 St. Francis Hall (SFH)
• TRiO Student Support Services
• Center for Professional Studies
• Accessibility Services
• Student Lounge
9 St. Clare Hall
(SCH)
• Duns Scotus Library
• Registrar
• The Center for Nursing Scholarship
3 Delp Hall (DH)
• Academic Support Center
4 Franciscan Center (FC)
• Gymnasium
• Athletic Director’s Office
• Conference & Theater
5 St. Agnes Hall (SAH)
• Center for Science Education
& the Environment
6 Lourdes Hall (LH)
7 Russell J. Ebeid Hall (REH)
• Welcome Center
• Admissions
• Ebeid Student Center
8 Mother Adelaide Hall (MAH)
• Appold Planetarium
• Advising
• Café Lourdes
• Dining Hall - The Grille
• Student Records & Cashier’s Offices
• Financial Aid
2 Carmel Hall (CAH)
1 Assisi Hall (ASI)
Lourdes University Buildings
Campus Map
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1
5
17
2
10
37
22
30
36
35
34
18
4
19
23
32
8
6
3
7
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29
Brint Rd.
Convent Blvd.
9
25
20 11
26
25
21
33
41
16
31
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40
c
d
13 14
b
12
a
Allen St.
McCord Rd.
Brinthaven Dr.
Silica Dr.
e
f
39
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FINAL TRANSCRIPT • ACT • SAT
Dear newest Gray Wolf,
Can you believe that your first semester of college at Lourdes University is right around the corner? I am very
excited for you and your family to become a member of the Gray Wolf community! During your time at Lourdes,
you are going to meet wonderful people and make friendships that will last a lifetime. In the classroom, you are
going to be exposed to new ideas and you will gain valuable knowledge to prepare you for life after college.
Before your new journey begins at Lourdes University, it is important to make sure you have taken the proper
steps to ensure that you start down a path towards success. Turning in the proper documents before you begin
the fall semester is essential. Please make sure your turn into the Admission Office no latter than August 19, 2016:
Your final official high school transcript
Most recent ACT/SAT test results
If we do not have your final official transcript it will prevent you from attending the first day of the fall semester
and will prevent you from registering for subsequent semesters.
These documents are essential as we want to ensure you are registered for appropriate courses and if your GPA or
test scores improve, your funding for college could improve through scholarships.
Please make sure you turn everything into us in a timely manner. I am looking forward to seeing you on campus
and if you have questions once you’re here, feel free to stop by my office. Have a safe and fun summer!
Sincerely,
Shawn T. Bussell
Director of Admissions
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Sponsored by the Sisters of St. Francis
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