2026 Summer Distance AST Student Residence Application

Summer Distance AST Student Residence Application

Your residency is not complete without the Welcoming Waivers Package. (Check your email.)
Today's Date

MonthDayYear
Date
Name

First NameLast Name
Preferred name to be called
Pronouns
University Attending

University NameUniversity ID Number
Program of Study

Program Enrolled inYear of Study
Residence Start Date

MonthDayYear
Date
Residence End Date

MonthDayYear
Date
ACADEMIC VERIFICATION To verify your ongoing enrollment, please upload one (1) of the free options from your student portal: a screenshot clearly displays your name, school name/logo, current term dates, enrolled courses, and enrollment status (e.g., full-time) Options: - Student Portal screenshot - Unofficial Transcript - Term account summary or payment receipt ADDITIONAL ACADEMIC VERIFICATION STATUS During your residence stay, you may be required to periodically submit an updated document to verify your active student status and ongoing enrollment. You may be asked to provide a Confirmation of Enrollment Letter. Students pay for any Registrar's Office charges.

Cancelof
YOUR PERSONAL INFORMATION
(International students are required to have a local mobile # and notify the Residence Manager as soon as it’s received.)
Birth Date

MonthDayYear
Email Address
Your best email for AST to communicate with you.
Phone Number
Your best phone # for AST to communicate with youFormat: (000) 000-0000.
Current Permanent Mailing Address

Street Address

Street Address Line 2

CityState / Province and Country

Postal Code / Zip Code
Some things we should be aware of (special needs, health-care status, allergies, etc.)
EMERGENCY CONTACT INFORMATION
Name

First/Last NameRelationship to You
Phone NumberEmail Address
SEXUAL VIOLENCE AWARENESS PREVENTION PROGRAM (SVAP)

AST, along with other universities in Nova Scotia, participates in a program to raise students' awareness of sexual violence. Each new resident is required to attend SVAP training shortly after arrival.

blanks
RESIDENCE LIVING Following move-in, rent is collected on the first of every month. Residence room rental fee is non-refundable and is not prorated. Once charged to your account, these fees apply for the full term of this agreement, and no credit or partial refunds will be issued for early move-out, non-use, or cancellation. There will be no credit for shortened stays. Any additional nights will be billed at $51/night. Students who are attending only one or two summer intensive courses will be billed at the usual short term stay rate. Check the statements below to confirm your understanding.
SECURITY DEPOSIT INFORMATION
Note that your security deposit is equal to, i.e. one month’s rent. Please see the webpage for additional information. https://www.astheology.ns.ca/residence/rates/ Your security deposit can only be refunded to your credit card. It's your responsibility to update us with your credit card information. By providing your credit card details below, you accept that your credit card will now be charged.
ARE YOU A CURRENT RESIDENT OR A NEW RESIDENT? If you are a Current Resident, you do not have to pay additional security deposit fees. If you are a New Resident, please provide your Credit Card information below to process your security deposit.
FLOOR ASSIGNMENT REQUEST – Select your preferred floor
ROOM REQUEST – Select your preferred washroom (No rooms close to the gender neutral bathroom.)
CREDIT CARD INFORMATION

Select which option(s) below you prefer.

Monthly Rate

AST Summer Distance Program 6-week term. (This fee will cover stays for AST Students only, who will be in residence from June 13 – July 25 in either a large or standard single room.)

$1,500.00CAD Quantity

Daily Rate

AST Summer Distance Program 6-week term

$50.00CAD Quantity

Additional Daily Days

AST Summer Distance Program 6-week term parking pass (mid-June to late July)

$50.00CAD Quantity

Parking Pass

AST Summer Distance Program 6-week term parking pass (mid-June to late July)

$141.00CAD Quantity

Total

$0.00CAD

Residence Payment
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

VEHICLE INFORMATION

Type of Vehicle (car, truck, motorcycle) Make and Model
Exterior colour
Driver's Licence

Driver's License NumberCanadian Province
Terms and Conditions
Signature

Powered by Jotform SignClear
Signature Details
Should be Empty: