COTR

Purcell House Residence - Application Form

Fill out the form below:

Personal Data

COTR Student Number (if you have one)

Returning Student

Have you previously lived in Purcell House?
Yes No

Social Insurance Number (not required)

Date of Birth:

 

Gender

Male Female

Please provide the following contact information:

First Name

Last Name

Middle Initial

 Street Address

Address (cont.)

City

 State/Province

 Zip/Postal Code

 Country

 Cell/Mobile Phone

 Home Phone

 E-mail

Emergency Contact Information:

Name

 Street Address

 Address (cont.)

City

 State/Province

 Zip/Postal Code

 Country

 Home Phone

Special Needs

bullet icon In the event that you are admitted to the Residence, will you require any special assistance by reason of disability, learning difficulty or medical conditions?
Yes
No

bullet icon State and describe disability/medical needs, if any, and needs associated with the disability.

Program Application

Program choices

Program applied for at COTR:

Year of program:
1st year |
2nd year

Program Type:
Certificate
Diploma

Program Load: 
Full-time
Part-time

Program Start Date:

End Date:

Arrival date at the residence:

Move out date:

Fees will be paid by:
Resident
BC Student Loan

Other: (specify)

Residence and living unit preferences

 

I prefer a:
|  

Parking

I will require parking at $10.00/month:
Yes No

 Vehicle License:
 

 Name of requested roommate:
 

APPLICATION FORM STATEMENT

Declaration

I hereby declare that the information I have submitted in this application is true and correct. Completion of this online application permits the College of the Rockies to confirm any information necessary to support my application to live in residence. Falsifying any documents or information submitted will result in the immediate cancellation of the application to live in the residences at COTR.

Completing this application to live in residence, I understand that this information along with subsequent information placed in my file, will be used for the purposes of the License Agreement and other purposes consistent with the mandate of the institution under the Colleges and Institutes Act. The use of this information will be in compliance with the BC Freedom of Information Privacy Protection Act (1992).

PRIORITIES ASSIGNED TO APPLICATIONS:

Any registered student is eligible to live in residence. Preference will be given to full-time students. Priority is given based on first come, first served.

Applications will be processed only when accompanied by a $35.00 application fee. Application does not guarantee accommodation. (Students registered through Royal Roads University are exempt from the $35.00 application fee)

Application fee payment can be submitted in the following ways:

By Cheque:
Cheques should be made payable to College of the Rockies and sent via mail to:
Purcell House Student Residence
2700 College Way, Bag 9000
Cranbrook, BC V1C 5L7

By Visa/Mastercard:
Please phone Purcell House Residence at 250-489-8282 to provide credit card information.

In Person:
Payments by cheque or credit card will be accepted at any College of the Rockies campus.

This application will not be processed if you do not accept the terms above.

Accept:

For further information, please contact:
Meghan Reiser Residence Supervisor;
Purcell House Student Residence,
Bag 9000, Cranbrook, BC V1C 5L7.

e-mail: purcellhouse@cotr.bc.ca
or call (250)489-8282 and apply by telephone.

Please check the accuracy of all information before selecting the submit button.

iconLast Step:
Please enter this number: 823926

into the text box.