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Returning Students
2015 / 2016
 CHECKLIST:
For returning Ambrose students, admittance to the residence for the 2015/2016
academic year will not be based solely on a first come basis, but rather on:
•
Academic, community, leadership and spiritual qualities and the student’s ability
to make a significant contribution to residence life and/or
•
The benefit a student may gain from living in residence and/or
•
Application submission date
All Residence students must hand in a completed Residence Application to reserve a spot,
even if they are required to live in Residence. Please submit applications by June 15th.
Complete this form and sign it. Ensure Health Form section is completed as well.
Residence option specified.
Meal Plan option specified.
Room reservation fee/damage deposit enclosed: $400 (includes a $25 non-refundable residence fee),
with the $375 deposit refundable until June 15*
(*see page 4)
*

Please consider your options, complete this Residence Application, and
return it, along with your non-transferable room reservation fee/damage
deposit of $400. Please make your cheque payable to Ambrose University.
RETURN TO:
Residence Director
Ambrose University
150 Ambrose Circle SW
Calgary, Alberta T3H 0L5
Tel: 403.410.2000 ext 2952 Fax: 403.571.2556
E-mail: [email protected]
The personal information collected on or in conjunction with this form is collected under the authority of the Personal Information
Protection Act (PIPA), the Statistics Act (Canada) and the Income Tax Act (Canada). It is required to determine your eligibility for admission
and will be used to contact you regarding programs and services. It will form part of your record as an applicant, student, and alumnus and
may be disclosed to academic and administrative units. Specific data elements may be disclosed to the Federal and Provincial Governments
to meet reporting requirements. All other information is considered confidential and will be used and disclosed in accordance with privacy
legislation. For more information regarding the collection or use of this information, please contact the Privacy Compliance Officer,
Telephone 403.410.2000 or E-mail [email protected].
returning students
application
for RESIDENCE
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Personal information
First Name:
Preferred name if other than first:
Gender: E-mail:
Middle Name:
Female
Last Name:
Maiden Name:
Male Date of Birth: Month / Day / Year
Home Phone:
Cell Phone:
Student I.D. Number:
Summer Contact Phone Number:
2
Home address
Street Address/PO Box:
City/Town:
3
Ambrose student Information
Undergraduate Student
Province/State:
Postal/Zip Code: Country:
Graduate Student* (*dependent on availability)
Program of Study
Year of Study
1st
2nd
This residence application is for:
Fall
Winter
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Your residence experience
Please describe your residence experience:
How do you plan on positively contributing to residence community life?
RA preference:
My roommate requests are:
For students 21 or older, in their third or fourth year of studies at Ambrose, in Seminary, or in the Bachelor of Education (After Degree):
3rd
4th
Year:
• Would you like to be placed on a Senior Student Pod*? (see page 4 for details)
Yes
No
• Do you anticipate applying to be a Resident Assistant next year? Yes
No
Please read and sign below:
I understand that the completion of this application indicates that I will abide by all the terms
and policies listed in the Ambrose Community Standards, Residence Policy, and the Covenant
of Residence Community Membership.
Applicant’s Signature:
Date:
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Suite Floor Plan Options and Information
Option A and D
Option C
Option E
Option B
Option A
Option B
Option C
Option D
Option E
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$1700 per semester
2 students sharing suite
2 beds
4 people to a bathroom
Single sink in each suite
$1500 per semester
3 students sharing suite
1 bed, 1 bunk bed
4-5 people to a bathroom
Single sink in each suite
Senior Student Pod only
$2400 per semester
Private room; 3 students
sharing a 3 bedroom suite
2 sinks, 1 bathroom
Shared living area
For students 21 or older
$2800 per semester
Private room
Sink in suite
Shared bathroom
Senior Student Pod only
$2100 per semester
Private room; 3 students
sharing a 3 bedroom suite
2 sinks, 1 bathroom
Shared living area
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Suite floor plan choices
Indicate your Suite Floor Plan Option (see above) in order of preference.
PLEASE NOTE: This is only your preference. You are NOT guaranteed the option you have chosen.
Room assignments will be based on availability and the discretion of the Residence Directors.
First Choice:
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Meal plan
Ambrose meal plans works on a declining balance system, where the student only pays for the food he or she purchases. A meal plan is required for all residence students. There is no tax on the residence meal plan or on meal plan purchases. Please indicate below which meal plan option you would like to select.
Rates subject to change
Second Choice:
Third Choice:
Rates subject to change
Option A
$1,800 plus $150 free flex dollars*
provides a student $17/day, 7 days/week, 15 weeks/semester
Option B
$1,600 plus $125 free flex dollars*
provides a student $19/day, 6 days/week, 14 weeks/semester
Option C
$1,400 plus $100 free flex dollars*
provides a student $20/day, 5 days/week, 14 weeks/semester
Option D
$1,200 plus $75 free flex dollars*
provides a student $16/day, 5 days/week, 15 weeks/semester
PLEASE NOTE: Monies carry over from Fall Semester to Winter Semester. Unused amounts at the end of April (over $10 & up to $200) may be deposited
into a future year meal plan. All meal plans are GST exempt. *Flex dollars can be used at various locations including Dominos and Waves Coffee Shop.
7Payment
Please carry over my current Damage Deposit as a Room Reservation Fee for the 2015-2016 school year.
(Please note: if you are charged for any damages this year, you will have to ‘top up’ your Room Reservation Fee to total $400.00.)
I have enclosed my room reservation fee/damage deposit of $400* by:
Signature(s) of account holder(s):
Card Number:
CVD Security #: (last three digits on back of credit card)
Name of Cardholder:
Expiry Date: (month /year)
Signature of Cardholder:
Date:
*
Cheque (please specify student’s name on cheque)
VISA
MasterCard
*Room Reservation Fee will NOT be refunded to students who withdraw after June 15.
Please consider your options, complete this Residence Application, and return it, along with your non–transferable room reservation fee/damage deposit of $400. Please make your cheque payable to Ambrose University.
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Additional Information
Damage Deposit
The damage deposit is your $400.00 reservation fee.* After you move into residence it will automatically become your damage deposit. Students
have until June 15th to withdraw their application in writing to the Residence Director(s) in order to receive a refund.
Senior Student Pod
There are Senior Student Pods for both men and women. The Senior Student Pods are for students who want a quieter, more independent
environment. There will be no curfew on this pod, but quiet will be enforced at 10:00 pm daily. Students will still be expected to attend floor
meetings, but small groups and other activities will be optional.
To be eligible for the Senior Student Pod, a student must meet one of the following criteria:
• be 21 or older, be in their third or fourth year of studies at Ambrose
• be in Seminary, or be in the Bachelor of Education (After Degree)
• special permission may be granted to other students by the Residence Director(s)
Floor Meetings
Every week the members of each pod get together for floor meetings. These meetings are a time to have fun, be encouraged, share, grow,
and pray together.
Curfew
Monday through Thursday curfew is 12:00 am. Friday through Sunday curfew is 1:00 am.
Suites will be furnished with:
• Bed and Mattress
• Desk
• Window Covering
• Sink
• Armoire
• Desk Chair
• Garbage Can
•Mirror
An inventory of the suite’s furniture is taken at the beginning of the school year. If there is anything missing or damaged at the end of the
school year, the student’s account will be charged with the appropriate amount.
Residence Lounge
The Residence basements are dedicated to lounge space. There are games tables, a home theatre room, two squash courts, and recreational spaces.
There is also a kitchen in the basement of each Residence for students to use.
Laundry Room
There are laundry facilities located in the basement of the Residence. The washers and dryers are coin operated and are $2.00 per load* for
each. Students’ access cards can also be loaded up with laundry money at the finance desk with a minimum of $10.
Internet
The whole Residence is equipped with wireless internet.
Parking
There is a parking lot for Residence students with 75 stalls. The cost per stall is $210.00/semester + GST.*
Mail
Each residence student will have a mailbox on campus. All mail should be addressed to:
150 Ambrose Circle SW, Calgary, Alberta T3H 0L5
Transit
Please check Calgary transit online at www.calgarytransit.com for more information.
* Fees may change at anytime without notice.
FOR OFFICE USE ONLY
Please forward to Student Development
Date R.R. Fee Rec’d
MC VISA
Cheque
4
150 Ambrose Circle SW
Calgary, Alberta T3H 0L5
Tel: 403.410.2000 ext 2952 Fax: 403.571.2556
E-mail: [email protected]
Health Form
 APPLICANT:
Please complete the following information and return this form with your
Residence Application form to the Residence Director at Ambrose.
First Name:
Last Name:
Province and Health Number:
Emergency Contact / Relationship to you:
health form
application
for RESIDENCE
Street Address/PO Box:
City/Town:
Province/State:
Postal/Zip Code:
E-mail:
Home Phone:
Cell Phone:
List medications taken on a regular basis and reasons for use:
List any food, drug, animal, or other allergies and their severity:
Have you adopted a diet preference (i.e. vegetarian, etc.)? If so, please explain:
Describe previous serious injuries/operations in the last two years:
Do you have any physical or psychological medical conditions that you feel the residence staff should know about?
Additional comments:

RETURN TO:
Residence Director
Ambrose University
150 Ambrose Circle SW, Calgary, Alberta T3H 0L5
Tel: 403.410.2000 ext 2952 Fax: 403.571.2556
E-mail: [email protected]
The personal information collected on or in conjunction with this form is collected under the authority of the Personal Information
Protection Act (PIPA), the Statistics Act (Canada) and the Income Tax Act (Canada). It is required to determine your eligibility for admission
and will be used to contact you regarding programs and services. It will form part of your record as an applicant, student, and alumnus and
may be disclosed to academic and administrative units. Specific data elements may be disclosed to the Federal and Provincial Governments
to meet reporting requirements. All other information is considered confidential and will be used and disclosed in accordance with privacy
legislation. For more information regarding the collection or use of this information, please contact the Privacy Compliance Officer,
Telephone 403.410.2000 or E-mail [email protected].
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