Office of Residence Life:

International Student
Residence Application & Agreement
NOTICE: A $150 Housing Deposit is required when you are offered and have accepted a room assignment.
*When do you plan to come to NJCU? (month and year)

*Personal Information
*All fields must be answered.  If any are not applicable, enter "N/A." 
Last (Family) Name
First Name
Middle Name
Postal Code
Date of Birth
*Email Address
Provide the email address that you use most often. We will be contacting you by email to provide you with additional information, as needed.
*Statistical Information
REQUIRED. If any answers to the following questions are not applicable, please enter N/A.
Have you previously completed college or university credits? If so, how many?
What is your major?
Expected Graduation Year (example: 2014, 2015)
Emergency Contact Name (Family)
Relationship to You
Phone Number
Email Address
Emergency Contact Name (Other)
Relationship to You
Phone Number
Email Address
Additional Details
Check YES or NO to indicate which of the following apply and provide additional information as applicable.
Select YES or NO as applicable.
Additional Details
New freshman
New transfer
New graduate student
Current NJCU resident student (provide current Building and Room number)
Current NJCU non-resident student seeking first time housing on campus
Are you in the Athletic program? (provide additional details)
Are you in the Nursing program?
Do you play music loudly?
Do you require silence while studying?
Do you prefer a non-smoker roommate?
Do you smoke?
Do you prefer an academic environment with quiet hours?
Do you prefer Substance Free Living?
Do you require special accommodations? (provide details)
Do you have special medical needs? (provide details)
Do you have other requirements or needs? (provide additional details)

Note: Applicants must maintain full-time status and a 2.0 grade point average to keep a housing assignment. We do not release roommates’ names and telephone numbers. The Office of Residence Life will give careful consideration to all requests but reserves the right to make administrative changes.

A $150.00 housing deposit must accompany this document.

All residents must participate in the University’s meal plan. Unused meal plan money does not carry from semester to semester.


1. The signer hereby applies for residence hall space at New Jersey City University for either the Fall, Spring or Summer semester as noted on the front of the Residence Application/Agreement and agrees to the following terms and conditions to reside in University housing:

2. The student occupant agrees to read and abide by the University Code of Conduct as stated in The Gothic Guide, and the rules and regulations of the Residence Life Program and the laws of the State of New Jersey.

3. The student occupant understands that the University may take appropriate action for conduct which is found by the University to be in violation of such rules and regulations, or which is otherwise detrimental to the welfare of the residence hall and/or University community. Such appropriate action may include assessing fines and/or penalties and dismissal from the Residence Life Program and/or University.

4. Room Assignment - The Office of Residence Life reserves the right to assign any student to another space for reasons of discipline, safety, health, unresolved conflict, or to achieve maximum space utilization.

5. The resident student agrees to complete and return all necessary documents by the deadline dates.

6. Room Fees - The applicant is responsible for the payment of fees for the space assigned prior to receiving a key and the condition of the space assigned until completion of the agreement or a formal withdrawal and check-out is processed.

7. Housing Deposit - The housing deposit will be credited towards the housing charges for the semester for which the application was made. The deposit is non-refundable if a room assignment has been made.

8. The resident student is expected to attend residence hall orientation programs and meetings during the check-in period.

9. The resident student accepts the space assigned and the condition found on entering and agrees to maintain such space, returning it to the University at the end of agreement or checkout in good condition as when the space was taken.

10. The resident student agrees to report all needed repairs to the Resident Assistant or Residence Life Staff person and will make no attempts to make repairs to University property.

11. The resident student agrees to keep the space assigned clean and accepts responsibility for all damage done regardless of whether the neglect was the result of doing an act or failure to do an act.

12. The resident student accepts responsibility for the common areas (lounges, kitchens, laundry rooms, bathrooms, computer labs, hallways and lobby) of the building.

13. The resident student agrees to occupy only the space assigned to him/her.

14. The resident student agrees to follow the check-in and check-out procedures as specified by the Office of Residence Life.

15. The resident student agrees to help maintain the campus facilities and will not place any objects, garbage or trash in any non- designated areas.

16. The resident will not alter the door locks and/or have additional locks installed.

17. The resident student will not dismantle any equipment, furniture, appliances or attach any articles to the floor, walls, ceiling, furniture or fixtures not in accordance with the established guidelines of the University.

18. The resident student will not bring any unauthorized noninstitutional or non-fire retardant furniture into the residence halls.

19. The resident student shall not allow anyone to share the premises, nor shall he/she keep roomers, boarders, or children, nor shall he/she assign or transfer said premises, or any part thereof, without the written approval of the University.
20. The resident student shall abide by the current guest visitation policies as printed in the Office of Residence Life Student Handbook.

21. The resident student understands that the use of fire alarms, fire detection devices or fire extinguishers except in case of fire, jeopardizes the safety of the residents and constitutes a serious offense. Any misuse of such equipment or devices is subject to prosecution; eviction from housing and liability for property damage, cleanup costs and fees required to restore extinguishers to a state of readiness.

22. The resident student agrees to evacuate the building in the event of an alarm and shall comply with evacuation procedures as stated in the handbook. The resident agrees to pay a fine if he/she fails to evacuate the residence facility when the fire alarm sounds.

23. The resident student understands that animals are not permitted in the residence halls. (See the Residence Life Handbook for additional information regarding Service Animals.)

24. The resident student understands that duly authorized representatives of the University and Residence Life Program will be permitted to enter the premises for the purpose of examining the condition thereof, making improvements and repairs, or for conducting inspections.

25. The resident student agrees that any personal property left in the residence hall after the expiration of the residence agreement period shall be considered abandoned and that the University may dispose of this property as it sees fit. The resident student forfeits any claim to the disposed property and will also be responsible for any cost involved to remove the property.

26. The resident student understands that the Residence Life Program is not responsible for storage of property. Although the University will exercise reasonable effort to protect students' property, as a public institution that is part of the state of New Jersey's Higher education system; the university is not responsible for loss, theft, or damage to personal property of students. Students are urged to obtain personal property insurance either with parents' household or by a special student policy available.

27. The resident student agrees to conduct himself/herself in an appropriate manner and will not permit anything to be done in, or about the premises which shall interfere with the rights of other residents. (Repeated complaints formally documented and substantiated in the Office of Residence Life will result in the termination of this agreement.) Any actions which threaten the life, safety or general physical well-being of another resident will likewise result in termination of this agreement.

28. The resident student agrees to respect the rights of other residents and subscribe to common courtesy and civility in the community environment. This includes controlling the volume of sound during quiet and courtesy hours.

29. The resident student understands that the University has the right to terminate this contract if he/she vacates or deserts the space; repeatedly interferes with the rights of other students; is responsible for repeated damages to premises,
furniture and fixtures; create physical and sanitary hazards; use premises for illegal purposes, or violates the terms of this
agreement and rules/regulations now in effect. 

30. A student wishing to cancel a housing contract must notify the Office of Residence Life in writing prior to refund deadlines outlined below. Any students withdrawing from housing after being offered a room assignment understand that the $150 housing deposit is non-refundable.

Refund conditions and deadlines:

  1. Students who officially withdraw from residence after the first week and before the third week forfeit 50% of the residence fee.
  2. Students who officially withdraw from residence after the first third (third week) of the semester will forfeit 100% of the residence fee
  3. Students must officially withdraw from housing by submitting a Housing Withdrawal Form Online.Upon submitting withdrawal form, please schedule a check –out appointment with your Residence Hall staff to complete the check-out process. Failure to schedule this appointment and / or check out appropriately will result in an improper check out charge of $65.00.
  4. Students must go through the checkout procedure with the Resident Life building staff.Students are not officially withdrawn until they have surrendered all University-issued keys and undergone a successful checkout process with an RC or RA in the building.
  5. The University reserves the right to post charges to student’s account to cover damages to the room and furnishings.


When you sign this form (by selecting "I Agree" and entering your First and Last name), you are agreeing to pay all rental and damage charges when due, abide by all rules and regulations established by New Jersey City University and the Office of Residence Life, and conform to all university regulations and policies as outlined in the student handbook - the Gothic Guide and Residence Life Program Student Handbook, and acknowledge that all of the above information provided by the applicant is correct and agrees to all of the details as stated in this Residence Application & Agreement.

I AGREE (PARENT / GUARDIAN) - if applicable
Parent / Guardian (if Applicant is under 18 years of age)
Parent / Guardian (if Applicant is under 18 years of age)

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