Please print or type
NAME: __________________________________ ______________________________________
(last) (first)
E-MAIL ADDRESS: ________________________________________________
HOME ADDRESS: __________________________________________________________________________
___________________________________________ Postal Code: _____________
TELEPHONE: ______________________________________________
PERMANENT ADDRESS (if different from above): ________________________________________
______________________________________________________________ Postal Code: ___________
PERMANENT TELEPHONE (if different from above): _________________________________
MALE [ ] FEMALE [ ] DATE OF BIRTH (mm/dd/yy): _____________
Please complete the following as it applies to your status in January 2005:
? I will be registered as a student of [ ] The University of Toronto
[ ] Other (please specify): _____________________________
? Student Number: __________________________________
? Faculty or Institute: _______________________________________________________________
? Program (please check the appropriate program and specify the degree you will be awarded upon
completion ? e.g., B.A., B.Sc., M.D., M.Div., M.B.A., M.A., Ph.D., Ed.D., etc.):
[ ] Bachelor degree ____________
[ ] Undergraduate diploma or certificate ____________
[ ] Professional or ?after? degree ____________
[ ] Masters degree ____________
[ ] Doctoral degree ____________
[ ] Post-doctoral
? I will be starting the _____ year of a _____ year program.
? Prior to September 2004, I will have completed the equivalent of _____ year(s) of full-time
studies at a post- secondary institute (college or university).
? I have previously lived in the Knox College Residence during the year(s) ___________________
Please indicate ? in order of preference ? the type of accommodation you are requesting by writing
the numbers 1, 2, and 3 beside your choices below:
[ ] ?Super? single (2 single rooms with a shared entrance for single occupancy) - $9,100.00
[ ] Single - $8,000.00
[ ] Double (2 single rooms with a shared entrance for double occupancy) - $7,400.00 per person
If you know another applicant with whom you would like to share a double room, please
provide the name of that person __________________________________________________
Over ?
- 2 -
EXPLAIN ANY PHYSICAL LIMITATIONS: (ie. arthritis, knee replacement, etc.) ___________________
_____________________________________________________________________________________
EXPLAIN ANY FOOD ALLERGIES: ______________________________________________________
NAME AND ADDRESS OF NEXT OF KIN OR EMERGENCY CONTACT:
_____________________________________________________________________________________
TELEPHONE: ____________________________________
NAME OF HOME CHURCH AND MINISTER: _____________________________________________
_____________________________________________________________________________________
? A current letter of reference in support of this application must be sent directly to the Knox
College RESIDENCE OFFICE by a Church Minister, High School Principal, Secondary School
Teacher, University/College Professor or Employer.
? Please attach a current résumé with this application form.
? Please include with the application form two passport-sized photos. (Upon acceptance of the
application, these photos will be used for identification purposes)
If this application is accepted, I agree to pay all necessary fees/charges/damages and to obey all
regulations governing the Knox College Residence. I understand that the continuance of my
tenancy at the Knox College Residence from one academic term or summer term to the next is at
the discretion of the Knox College Administration.
______________________________________ _______________________________________
Signature Date of Application
If the applicant is under the age of 19 years, the applicant?s parent or legal guardian must also sign
this form.
______________________________________ _______________________________________
Signature of Parent or Legal Guardian Date of Application
PLEASE SEND APPLICATIONS, BY POST, TO:
Residence Office, Knox College
59 St. George Street,
Toronto, Ontario, Canada M5S 2E6
Application deadline is Friday, October 8, 2004. All application documents must be originals (no
photocopied, faxed, or e-mailed copies will be accepted).
FOR MORE INFORMATION:
Telephone: (416) 978-0168
Fax: (416) 971-2758
E-mail:
[email protected]Internet:
http://www.utoronto.ca/knox