FOR OFFICE USE ONLY
Instructions: Please read carefully and print clearly.
1. Please complete and sign application.
2. Read and sign the Residence Hall Agreement.
3. Return completed application together with the required deposit
to the Residence Office in Grand River Hall, room 222.
Surname
Building: __________ Room __________
Cancel Date: _______________________
First
(
Home Street Address
Province
Birth date:
(
) Male
City
Postal Code
/Day
) Female
/Month
/Year
Emergency Contact — Name
Street
Academic Major
Telephone
WLU Student Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Address as above ☐ OR
Telephone
City
Province
Current Academic Year (circle one) 2
Postal Code
3
4
Grad
Email Address (please print clearly):
All upper year students will be assigned to single rooms in apartment-style residence accommodations.
All students living in residence are required to purchase a convenience plan. By agreeing to live in residence, you will have $400/term applied to
your One Card Account. If you wish to increase this amount, you will need to contact Laurier One Card. The balance of the Convenience Plan can
be carried over into the following school year. For information about the mandatory convenience plans and vendors, please visit the Laurier
OneCard website at: http://wlu.ca/onecard/meal-plans.html
Please initial to acknowledge your understanding that you will have a Convenience Plan while you live in residence:
Please Read Carefully:
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A non-refundable residence deposit of $600 must accompany this application form. This contract is an 8 month contract, beginning on
Sunday, September 6, 2015 and concluding on Saturday, April 30, 2016. If students choose to leave residence before the end of the
agreed-to occupancy period, they will be responsible for the full fees for their assigned room for the entire occupancy period. For
students who have indicated need for only a 4 month lease, they will need to clarify that when handing in their residence application.
For completed applications submitted by April 30, 2015, the 2014-2015 residence fees apply to students. For applications submitted
starting May 1, 2015, the cost of residence will be the 2015-2016 residence fees.
Students who choose to live in residence for the 8 month contract are able to apply for summer residence 2015 or summer residence
2016 at a discounted summer residence cost. If students are interested, they would need to contact the Residence Office prior to the
summer term.
The $600 residence deposit is non-refundable after June 1, 2015.
Students have until 1:00 p.m. on Friday, September 11, 2015 to pick up their residence keys and move into residence, unless
th
arrangements have been made with the Residence Office. If keys are not picked up by September 11 , the room assignment will be
cancelled; however the student will not receive a refund of the $600 residence deposit.
Students who are successful in receiving a residence space must vacate their residence room 24 hours after their final exams, unless
permission has been granted by the Residence Office.
Smoking is not permitted in any WLU building, including residences.
There are limited parking spaces available, and acceptance into residence does not guarantee you a parking permit. If you would like to
apply for a permit in the residence parking lottery, please visit the http://legacy.wlu.ca/homepage.php?grp_id=10305 or contact Service
Laurier at the Brantford Campus.
______________________________________________________________________________________________________
I have read, understand and agree to this application and its contents.
Date: ____________________________________
Signature: _____________________________________________
THE RESIDENCE HALL AGREEMENT OF THIS APPLICATION MUST ALSO BE SIGNED►
Residence Hall Agreement
Each applicant is required to read and comply with the following conditions regarding living in residence at Wilfrid Laurier
University:
1.
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4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
I am responsible for all the charges for my residence room, meal plan, and for damages and/or losses that I am considered to
be accountable for by the Department of Residence or the University.
Failure to abide by the financial arrangements required by the University, or failure to make payment of damages or other
assessments, will result in the University withholding my examination results, transcripts or degree.
My assigned room will not be held for me after the Friday preceding the first day of lectures for the term to which I applied,
unless I notify the Residence Office, in writing or by telephone, prior to that date and make satisfactory arrangements.
It is my responsibility to provide the Residence Office with my local telephone contact information while I am living in
residence.
I may not change rooms without the consent of the Residence Office, in consultation with the Residence Life Management
Team. This change will not be official until I exchange my keys in the Residence Office and fill out the appropriate paperwork.
I shall carry appropriate and adequate insurance coverage for fire and property damage and public liability insurance during the
term of the residence agreement and any renewals or extensions thereof, at my own expense. Such policies shall be written on
a comprehensive basis with limits of not less than $2,000,000.00 for any one occurrence.
The occupancy period in residence begins September 6, 2015 until 24 hours after my last scheduled exam in the Winter Term.
Under exceptional circumstances, a student may request permission from the Manager, Residence Life to exceed the
occupancy period for a limited time. There may be a daily/weekly charge for occupancy before or after the official occupancy
period.
I will engage in and maintain registration as a full-time student at Wilfrid Laurier University in a program of studies leading to a
degree. I further acknowledge, by my acceptance of the tenancy, that if my registration status changes to part-time student
during my tenancy, I am obligated to notify the Residence Office to review the status of my residency.
If I am required to leave residence as a result of my student registration status being voided at Wilfrid Laurier University, my
residence fees and charges will only be refunded based on the date of a completed withdrawal. A proper checkout must be
completed with my Residence Life Don and Residence Life Area Coordinator, and the room/building keys must be returned to
the Residence Office for the withdrawal to be considered complete. No refunds will be considered after January 31 for the
Winter Term.
I understand that by accepting my residence keys I am committed to the full 8-month occupancy term of this residence
contract. If I choose to leave residence while maintaining student registration at Wilfrid Laurier University, I understand that
my residence fees and charges are not refundable.
If I am required to leave residence for conduct related reasons, I understand that my residence fees and charges are not
refundable. Potential reasons include conduct set out in paragraphs 13 and 14 of this agreement, as well as non-academic
misconduct set out in the Wilfrid Laurier University Student Code of Conduct and Discipline (University Policy 12.2).
Withdrawal from residence for medical reasons is allowed when a statement from the attending physician is presented and
found acceptable by the University physician and the Manager, Residence Life. An administrative fee equivalent to the
residence deposit will be charged. All residence fees and charges must be paid in full up to the date when the student
withdraws.
If I am found to be in possession of, using or trafficking illegal drugs or substances, I understand that my residence contract may
be immediately cancelled and I may be required to vacate my assigned room immediately for conduct related reasons.
Behaviour considered harassing or violent as determined by the Department of Residence will result in immediate eviction
from residence.
If I require emergency medical assistance, or emergency assistance of any sort, I agree to allow the Department of Residence to
contact my emergency contact. This emergency contact will be disclosed to the Department of Residence upon move-in to
residence in the “Emergency Contact Information form” and should the contact change during the term of my residency, I will
notify the Department of Residence immediately.
I have read and understood this “Residence Hall Agreement” and I agree to abide by all rules, regulations and guidelines herein,
and as set out in the Residence Guidebook and on the Laurier website at http://www.wlu.ca/life-atlaurier/residence/index.html.
Date: ________________________
Signature: ______________________________________________
This information is collected under the authority of the Wilfrid Laurier University Act to administer the university-student relationship. This includes but is not limited
to maintaining your academic and ancillary records, contacting you, and others on your behalf, and releasing such information as is appropriate for the operation of
the university. Please visit our Privacy Co-ordinator's web page www.wlu.ca (under "Resources") for more examples of potential uses of your personal information.
Questions may be directed to the Co-ordinator via the contact information posted on their website.