Application To Rent

The Artium Student Residence ( ASR )
125 Dundas Road,
Kelowna, BC
V1X 3X6

Room Number Assignment: As we place a high importance on reviewing your preferences and trying our best to match you with roommates who share similar preferences, room numbers will be assigned 3 weeks prior to move in.

Rental Rate: $750 per month
Lease term 12 months
To apply, the following is required:

  • You must be18 years of age or over
  • All Applicants ID will be verified prior to approval
  • Applicant is required to fill out all parts of this application marked *
  • Filling out the ‘Preferences’ section is optional, but will greatly aid in proper room mate matches
  • ASR will verify information supplied to qualify applicants
  • Tenancy is single occupancy only ( One person per Room )
  • ASR generally processes applications within 5-7 business days, but applications can take longer if more information is required from the applicant.

If ASR approves applicant:

  • If approved, to hold a room, ASR requires a half month’s rent as security deposit paid in certified funds, and a signed Lease Agreement.


First or Given Name*:

Last or Family Name*:

Social Insurance Number:

Drivers Licence Number or other Government Issued ID*:

Province/State of Issue of DL or other Government Issued ID*:

Birth Date*:
MM:   DD:   YYYY:

Female     Male

Cell Phone Number* (You must add 1 before your number if it is long distance calling from Kelowna):



Current Residence

Street Address*:



Province / State*:

Postal Code / Zip Code*:

Telephone Number (If Different From Cell Phone):

Landlord Name*:

Landlord Telephone Number*:



Institution you will be Attending*:

This will be my _____ Year ( 1st, 2nd, 3rd, etc )*:

Course of Study*:

Student ID Number*:


Employment History – Most Recent

Employer Name*:

Employer Work Telephone*:

Type of Business*:


Date Started*:

Date Finished*:



Will a Parent, Guardian or Other Individual be Paying your Rent?

If Yes, please provide their name, email address and telephone number:



Please provide 2 references – They should not be related to you

Reference 1 Name*:

Reference 1 Telephone*:

Reference 1 Relationship to you*:

Reference 2 Name*:

Reference 2 Telephone*:

Reference 2 Relationship to you*:

Will You Require parking?:
No      Yes

If Yes, Please provide your vehicle Make, Model and Licence Plate Number:


Room Mates Match

Please list the name (s) of other students that are applying to live at ASR, whom you would like to be matched with in the same suite. NOTE: These students will also need to list your name on their application in order for us to match you together.


Residence Advisors

If you have previously been trained, and served as an RA in on Campus Housing, and you wish to apply for an RA position in ASR, please fill this in, noting the Institution you received your RA training at, and years served as an RA.  Students serving in the position of RA at the ASR will receive a substantial reduction in their monthly rent.



This section is optional for you to complete.  However, the more information we have about your lifestyle preferences, the better we will be able to properly match you with the other room mates you will be sharing your suite with.

Please select a number from 1 to 5 below each statement to indicate to us how important each of these is to you.

1 means it’s not important at all to you.
2 means it might be a consideration to you
3 means this is a consideration for you
4 means this is quite important to you
5 means this is very important to you


You would like to be matched with roommates who are the quiet type:
1     2      3      4      5     

You’re an early riser, and want to live with early risers:
1     2      3      4      5     

You stay up late, and want to live with night owls:
1     2      3      4      5     

Alcohol – You prefer to live with non-drinkers:
1     2      3      4      5     

Smokers – You prefer to live with non-smokers:
1     2      3      4      5     

You’re very neat and tidy, and want to live with similar students:
1     2      3      4      5     

You would like to live with same gender roommates:
1     2      3      4      5     

You would like to live with mixed gender roommates:
1     2      3      4      5     

You would like to live with roommates in the same course of study:
1     2      3      4      5     

You would like to live with roommates who are considerate of Religious beliefs:
1     2      3      4      5     

Please provide the name and contact details of someone we can call in the event of an emergency:

Please provide any other comments you feel would help us in providing you with the best living experience, including any other lifestyle preferences, mobility or dietary issues, etc. While we accept floorplan requests, we can not guarantee that you will be assigned to a suite with the specific floor plan you ask for.

Please provide us with your preferred method of payment. We will offer:

How did you hear about the Artium?

*I, the UNDERSIGNED APPLICANT, confirm that the information contained in this application is true and correct, and I authorize Artium Student Residence to obtain my credit report through a credit reporting agency and I authorize the contact of and information release, to those named in this application, to verify all information contained in this application. Artium Student Residence is also authorized to share my information with other agencies and affiliated companies.


MM:   DD:   YYYY: