18.19 Application

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Thank you for your interest in becoming a resident at the JPII Newman Center. Please note the application cannot be saved, also all fields marked with an * are required. If you have any trouble, call 402.557.5575

Student Information

Name*

First Name

Last Name

Preferred Name/Nickname

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Personal Email*

School Email

Cell Phone*

Date of Birth*

Gender*

Female Male

Do you have any medical conditions or mental health conditions that we need to be aware of? i.e. disabilities, anxiety, depression, allergies, heart conditions, etc.*

Do you currently live at JPII Newman?

Yes! I am renewing my lease. No! I will be a new resident.

Parent/Guardian Information

Parent/Guardian Name*

First Name

Last Name

Parent/Guardian Email*

Parent/Guardian phone*

Faith Information

Religion

Catholic Protestant Non-Denominational None

Other:

What church do you currently attend?

Attending church and/or quiet time for daily prayer are important to me.*

Yes No

JPII Newman is an intentional Catholic community. What does this mean to you? Why do you desire to live here?*

Miscellaneous

How did you hear about the JPII Newman Center?*

Friend/Family Spirit Catholic Radio My Church My School Be A Mav Days UNO Website Internet search

Other:

Please list the name of the family or friend who referred you:

Current Resident Room/Roommate Preference

Please note that roommate requests and room preferences will be considered through May 15th. After May 15th, requests may or may not be accomodated.

Please list the names of people you would like to room with next year.

Do you want to stay in your current room or move to another room?

Stay in Current Room Move to another room

We can guarantee a request to stay in your current room (until May 15th) but we cannot guarantee a request to change rooms.

What is your room/floor preference?

Sign and Submit

Signature*

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Application Fee $

Student Information

Parent/Guardian Information

Academic Information

Roommate Profile

Faith Information

Miscellaneous

Current Resident Room/Roommate Preference

Sign and Submit

Your application is not considered complete until we have received your $75 application fee.

Hitting "Submit Your Application" below will take you to a PayPal page where you can pay with credit card or through PayPal.

Thank you so much for applying! Check your email for your next step.