COTR Student & Public AccommodationCOTR

Purcell House Residence - Application Form

Fill out the form below,
 

Personal Data
COTR Student Number (if you have one)
Have you previously lived in Purcell House? Yes No
Provincial Education Number (if you have one)
Social Insurance Number (not required)
Date of Birth:    
Gender   Male Female
Citizenship: Canadian Resident Permanent Resident

Please provide the following contact information:
First Name  
Last Name  
Middle Initial
Street Address  
Address (cont.)
City  
State/Province  
Zip/Postal Code  
Country  
Work Phone
Home Phone  
FAX
E-mail

Emergency Contact Information:
Name  
Street Address  
Address (cont.)
City  
State/Province  
Zip/Postal Code  
Country  
Home Phone  
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
State and describe disability/medical needs, if any, and needs associated with the disability.

Program Application

Program applied for at COTR: 

Royal Roads students please type: Royal Roads
Year of program: 1st year | 2nd year
Program Type: Certificate Diploma

Royal Roads Students check "Diploma" and "Part-time"
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:
 |
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:
Pam Catsirelis 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.