APU Campus Life Housing and Meal Plan Application and Contract

Welcome to the student Campus Life Housing and Meal Plan Application and Contract.
If you have not done so already, please review this important information about APU Campus Life before submitting your application:
- Overview and Important Dates for this Academic Year
- Policy and Guidelines
- Current Rates
- Terms and Conditions
- Housing Application Process Overview
- Housing Options

Personal Information

 * indicates required field
 * First Name
Middle Initial
 * Last Name
Preferred Name
 * Telephone  
  * Date of Birth   
Identified Sex

If you answered Other (Please Specify):
Are you a transfer student?
 * Email Address  
 * Mailing Address
 * City
 * State
 * Zip  
 * Class Standing when you'll move in
 * Have you ever been convicted of a felony?
If "Yes", please explain
* Parking and vehicle registration is free
Make of Vehicle
Model of Vehicle (and Make if 'Other' is selected above)
Vehicle Year
Color of Vehicle
License Plate Number
License Plate State
Contract Date Academic Year
Term initially moving on campus

* Full academic contract length is automatic for first year students under 21. Single semester contracts are only for final semester seniors, eco-league exchange, and students arriving in the spring semester.
Contract Length
* North Atwood is primarily for first time freshman, 18-20 years of age. Meal plans are included automatically for all housing assignments and are included in the cost. North Atwood residents are assigned the Gold Meal Plan and Segelhorst Hall and University Village are assigned the Silver Meal Plan. All meal plan questions should be directed to Campus Life.
Building Preference

Room Preference
If your first preference is not available, is there any assingment you would not accept? Please explain. *

Roommate & Suitemate pairing questions

For the following questions choose what best describes you.
Bed Time:


Waking Up:


Noise Level:

* APU is a smoke and tobacco free campus.

Roommate Smoking:

What adjectives best describe you:
* In the space below, please provide any additional information about yourself that may help us match you with a great roommate – this could include: sports you play; music you listen to; TV shows or films you enjoy; games you like to play; books you have read; reasons for coming to APU and/or Alaska; or what you enjoy in your spare time. 

Emergency and Medical Contact Information

Please provide the best contact information for you, in case of an emergency. Include your most up to date insurance information. If you do not have insurance, please put N/A or TDB in the following fields.
Emergency Contact 1: 
 * Name
 * Phone
 * Relationship
 * Email  
Emergency Contact 2: 
 * Name
 * Phone
 * Relationship
 * Email  
Insurance Information:
Please note: All students living on campus are required to have health insurance. Please contact the Dean of Students Office at APU for more details at DOS@alaskapacific.edu.
 * Insurance Provider
 * Policy Number
 * Name of Policy Holder
 * Relationship to Policy Holder
Please Note: All students living on campus are required to have Health Insurance.
Do you have any illnesses or disabilites which require special housing, meal plan, or considerations? *

If "yes", please explain:
Important Information Campus Life Staff Should be Aware of:
Important Allergy Information Campus Life and Dining Hall Staff Should be Aware of:
* All food allergies will be shared with the dining hall staff.
Please select any of the following that apply to you:

Health Information

We strongly encourage you to visit your family doctor before arriving at APU to ensure your immunizations are up-to-date. You are required to have the MMR and Tetanus Immunizations to live on campus. We do not require official medical records verifying your vaccination history, but do ask that you provide us with the dates you received the immunizations below (in mm/dd/yyyy).
The MMR vaccine requires two doses on or after the first birthday with a minimum of 30 days between doses. If month and year of the first dose is not available, documentation of the second dose on or after December 1989 must be provided.
The Tetanus-diphtheria needs to have been received within the past 10 years. Dates of the Immunization accompanied by student's signature will be accepted as evidence.
Exemptions are listed below.

MMR Vaccine History

- choose one of the following options:
1st Dose Date:    
2nd Dose Date:    
- or -
2nd Dose Date:    

Tetanus-Diphtheria History

Date of most recent Vaccine within the past 10 years:    

Other Immunizations

While not required, the following immunizations are highly recommended by Alaska Pacific University and the American College Health Association. In the space provided, please indicate which of the following vaccinations you have received by entering the dates you received them (in a mm/dd/yyyy format).

Hepatitis A

1st Dose on:    
2nd Dose on:    

Hepatitis B

1st Dose on:    
2nd Dose on:    
3rd Dose on:    

Varicella (Chicken Pox)

Immunized on:    

Meningitis Vaccine

Immunized on:    
I meet the following exemption and thus do not need the Measles immunization:

Contract and Deposit

Your contract and deposit reserve a place for you in the residence halls contingent upon your acceptance to the University by the Admissions Office. Only fully admitted, full-time students will be allowed space in our residential facilities. For all admitted students with housing contracts and deposits, the Office of Campus Life will work to assign rooms based on preferences specified in the contract. Please be aware that while we are always trying to give everyone their first choice of building and room, we may be required to assign you to a room that is not your first choice based on availability. In addition, we will do our best to match you with appropriate roommate and suitemates that most accurately match your profile.
A $400.00 Housing Deposit is due before you move in. Full deposit payment is due by August 1 for fall move in, or December 15 for spring move in. You can pay that over the phone at (907) 564-8352 or online at https://www.alaskapacific.edu/payonline/.
Contracts must be cancelled by June 1 for fall move in, and November 1 for spring move in. *

Any student needing housing during the winter or summer breaks must apply and pay additional charges to stay in the campus residence halls during those periods. A separate housing contract will be available for those breaks.

Terms and Conditions

By checking the box below I acknowledge and agree that I have read the terms and conditions of the Contract and Campus Life Handbook and agree to abide by them, as well as the rules and regulations of Alaska Pacific University and the Campus Life Program.
I understand that cancellations must be made in writing and that I am liable for appropriate cancellation fees if this contract is cancelled.
I agree to pay APU for housing and food service charges for the length of the contract.
Alaska Pacific University offers its living accommodations to APU students without regard to race, color, religion, or national origin. All spaces are given on an available basis.
I understand that I am responsible for my living space and agree to pay for any damage that happens while I am living there. Costs may be split between roommates if a sole responsible party cannot be determined. Fees will be billed to my student account.
I also acknowledge that I will be responsible for all physical keys and key cards I receive. I am financially responsible for any keys or key cards that I lose and will have my student account billed appropriately.
I understand that I must have a housing deposit on file before I can move into campus housing. The University will hold my deposit until I move out of housing for the final time, at which point the deposit will be refunded back to my student account. If I have outstanding fees on my student account, the housing deposit may be used as a credit towards my fees when it is refunded to my account. If there are zero fees on my account, a check will be cut and mailed to the last address I have on file with The University.
By checking the box below, I understand that my bill is due in full to The University by the first day of classes. If I need to, I can arrange a payment plan through Student Accounts by emailing studentaccounts@alaskapacific.edu or calling (907) 564-8352. I understand that Campus Life is not able to accept payments for any parts of my bill. *

Contract Overview

Prices listed here are for one semester, which includes one block and one session. There are two semesters in one academic year. If you need a housing or meal plan for block only (Eco-League Students), please contact the Office of Campus Life at Housing@alaskapacific.edu. Meal plans are required for all students living on campus and are already included int he housing costs.
Students living in Segelhorst of University Village may upgrade their meal plan from the Silver to Gold plan. However, Students living in North and South Atwood cannot change their meal plans from the Gold to Silver plan.
Cancellation Policy Reminder:
The contract may be terminated upon written notice given to the Office of Campus Life by the student, or to the student by the Office of Campus Life.
All cancellations must be in writing.
Failure to follow appropriate cancellation or move out procedures may obligate the student to room and board charges and/or Improper Cancellation/Check-Out Fees.
A first time contracted housing student who has not moved into the residence halls has until June 1 to cancel their contract without penalty. A contract cancelled after June 1 will incur a $400.00 fee (the housing deposit). This fee does not apply if the student is not admitted to APU.
The cancellation fee for any returning student, regardless of cancellation date, is $500.00.

Meal Plan Overview

Gold Plan (North and South Atwood)
19 Meals a week at the dining hall, plus a declining balance of $50.00 that can be used at the dining hall, coffee cart, and Farmer's Market (when open).
Silver Plan (Segelhorst and University Village)
A declining balance of $500.00 that can be used at the dining hall, coffee cart, and Farmer's market (when open).
Dining Hall Hours:
Breakfast - M-F: 7:30-8:30 AM
Lunch - M-F: 11:30 AM-1:30 PM
Dinner - M-F: 5:15-6:30 PM
Brunch: Sat/Sun: 10:30 AM-Noon
Dinner - Sat/Sun: 5:00-6:00 PM


By signing below, I ascertain that all of the above information in this document is accurate and true to the best of my ability and knowledge.
If you are under 18, make sure that all submissions listed are signed by your parent or guardian listed.
Signature Date:    
Parent/Guardian Signature:
Parent/Guardian Signature Date:    

Campus Life Contact Information

Alaska Pacific University
Campus Life
4101 University Drive
Anchorage, AK 99508
P: 907-564-8299 F: 907-564-8806
E: Housing@alaskapacific.edu