Residence Hall Application
$25.00 non-refundable application fee
This fee is required to process this application. 
Money order or check payable to: United Tribes Technical College
Credit card payment - call: 701-255-3285 ext 1425
 

 I am applying for: 

 

Personal Information:
 

 Full legal name: 
 Mailing address: 
 City:
 State:
 Zip:
 Home Phone:
 Cell phone:
 Emergency:
 Date of Birth:
  Male         Female
 Email: 

 


Residence Hall Preferences:

Students that reside on campus only: Please indicate your choice of residence hall. Every effort will be made to assign you to your preference, however, it is not guaranteed. 
PLEASE NOTE: If you have a documented disability or medical condition and you need to request a specific room type you must first contact Disability Support Services at 701-255-3285 ext 1516

Halls:

   Itan’can Oyanke Leadership Lodge (Co-Ed)     

 


Emergency Contact Information (at least one contact is required):
 

 Full Name: 
 Relationship:
 Address:
 Home Phone: 
 Cell Phone: 
 Work Phone: 

 

 Student Signature: 
 Date: 
 Signature of parent/guardian (required if student is under 18):
 Date: 


 

Roommate Questionnaire
(This form applies to dorm students only)

Please fill out the following information below. The Housing Department will use this information to assign an appropriate roommate. It is import that the student fill out the form accordingly. 
 

 Name: 
 Date of birth: 
 
What time do you expect to wake up during the weekdays?​​​​​
             
 
 What time do you expect to go to sleep during the weekdays?
             
 
 In what condition do you maintain your room?
     
 
 What is the sound level that you prefer while you're studying?
     
 
 Do you consider yourself:
       
 
​​​​ How often do you expect to have guests in your room?
     
 
 How would you describe the activity in your room?
     
 
 Will you be joining a sport?
 If yes, do you want to live with a teammate?

 If you have already met someone that you would liek to be your roommate, please list preferred roommate's full name:
(Roommate must be mutual and will be contingent upon space available and the date applications are turned in)
  1st choice: 
2nd choice:  
 
 List some of your hobbies, interests or activities: 

​​​​Do you have any special needs concerning your Residence Hall assignment?