Health & Wellness Residential Learning Community Application
INSTRUCTIONS
You should use this application form to apply to the
Health & Wellness Residential Learning Community
, which is located within the Christie/Wright/Patterson residential complex.
Returning/Upper-Level Students
should submit this application - and a Department of Residential Life Housing and Meal Plan Contract - by
Friday, March 6, 2009
, for best consideration.
Incoming First-Time, First-Year Students and Exchange Students
should submit this application - and a Department of Residential Life Housing and Meal Plan Contract - by
June 30, 2009
.
Transfer Students
:
On-campus housing cannot be guaranteed for any transfer students. While we will gladly review your application to join this community, we will not be able to offer you a spot in the community unless the Department of Residential Life is able to offer you a housing contract. Please visit the Department of Residential Life's Website for additional information:
http://reslife.uvm.edu/?Page=students/getting_room/overview.html&SM=students/getting_room/getting_room_sm.html
ABOUT THE HEALTH & WELLNESS RESIDENTIAL LEARNING COMMUNITY
The Health & Wellness Residential Learning Community (HWRLC) is now in its third year and, while growing, still has a wonderful community feel. Housed within the Christie/Wright/Patterson residential complex, all of our programming spaces are on the first floor of Wright, while our residents are housed on the second, third and fourth floors with fabulous views of the mountains. Programming spaces include a demonstration kitchen for cooking classes and hosting community get-togethers, a yoga/meditation/exercise space, discounted access to the Wright Fitness Center, a classroom/group room, and administrative offices for faculty, staff and work-study students.
HWRLC students represent a wide variety of academic majors, yet share a common interest in healthy lifestyle choices. Participation in the HWRLC provides the opportunity for students to live together in a setting where faculty, staff and students work collaboratively to promote and support personal and academic growth.
There are several levels of engagement available for HWRLC students. All first-time HWRLC students participate in a one-credit course on the six (6) domains of health and wellness (physical, emotional, intellectual, spiritual, social and environmental). During your second semester you can also take an optional HWRLC Leadership course. Using that first year experience as a foundation, students who wish to live in the HWRLC in subsequent years will continue to build upon their personal areas of interest, as well as contribute to the development of a larger community grounded in the principles of health and wellness.
For more details about the Health & Wellness RLC, please visit the HWRLC Website: http://www.uvm.edu/rlc/hwrlc
Section 1
ABOUT YOU
Please enter your full name:
First Name:
Middle Name:
Last Name:
Preferred Name if different from First Name:
Please enter your 9-digit UVM ID number (a UVM assigned number, usually starting with 950 or 951). Use numbers only; no dashes.
ID Number:
Please enter your UVM e-mail address. If you do not have a UVM e-mail address yet, enter your preferred e-mail address:
E-Mail Address:
Please enter your UVM Network ID, if known (e.g., gsmith, hdean, bclark1):
Net ID:
What is your gender?
Gender:
(Click here to choose)
Female
Male
Transgender
Other
What is your preferred personal pronoun?
Pronoun:
(Click here to choose)
He
She
Ze
Other
No Preferred Pronoun
Please select your anticipated year of graduation from UVM:
Graduation Year:
(Click here to choose)
2013
2012
2011
2010
2009
Continuing Ed/Non-Degree
Please indicate your current student status:
Status:
(Click here to choose)
Currently enrolled UVM student, currently live on campus
Currently enrolled UVM student, currently live off campus
UVM student planning to return from a leave of absence
UVM student planning to return from study abroad
Newly admitted first-time, First-Year student
Newly admitted Transfer Student
Exchange Student, entering Fall 2009
Exchange Student, entering Spring 2010
Academic major and minor:
Academic Major:
Academic Minor:
UVM college or school that you are enrolled in:
College/School:
(Click here to choose)
Agriculture and Life Sciences
Arts and Sciences
Business Administration
Education and Social Services
Engineering and Mathematics
Environment and Natural Resources
Nursing and Health Sciences
Continuing Education Non-Degree
Please provide your current
campus
address and phone (if applicable):
Room/Box Number:
Residence Hall:
(Click here to choose)
Austin
Buckham
Chittenden
Christie
Converse
Coolidge
Cottages
Davis
Jeanne Mance
Hamilton
Harris
Hunt
Living/Learning A
Living/Learning B
Living/Learning C
Living/Learning D
Living/Learning E
Marsh
Mason
McCann
Mercy
Millis
Patterson
Ready
Redstone
Richardson
Sichel
Simpson
Slade
Tupper
Univ Heights North
Univ Heights South
Wilks
Wills
Wing
Wright
542 Phone Number:
Please provide your
permanent/home
address and phone:
Street1:
Street2 (if needed):
City:
State:
(Click here to choose)
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
British Columbia
California
Canal Zone
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Is
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Trust Territories
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code:
Country:
(Click here to choose)
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
Brit Ind Ocean Territory
Brunei Darussalm
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Rep.
Chad
Chile
China
Christmas Islands
Cocos Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Dem Rep. of Korea
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
France Metropolitan
French Guiana
French Polynesia
French So. Territories
F.Y.R. Macedonia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadaloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard McDonald Island
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (South Korea)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mariana Islands
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherland Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue Island
Norfolk Island
Northern Mariana Island
Norway
Oman
Pacific Islands
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Republic of Korea
Reunion
Romania
Russian Federation
Rwanda
S Georgia & Sandwich
Saint Pierre & Miquelon
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierre Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somali Republic
South Africa
South Korea
Spain
Sri Lanka
St. Helena
St. Kitts-Nevis
St. Lucia
St. Vincent/Grenadines
Sudan
Suriname
Svalbard & Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos
Tuvalu
United States
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Is.
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands: British
Virgin Islands: US
Wallis & Futuna Islands
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Home Phone:
Cell Phone:
Applying for admission starting which semester?
Admission semester:
(Click here to choose)
Fall 2009 (August)
Spring 2010 (January)
Section 2
ABOUT YOUR INTEREST IN THE HWRLC
Are you applying to any other UVM Special Interest Housing Options?
Applying to other special interest housing options?
(Click here to choose)
Yes
No
Not sure yet
If you are applying to other UVM Special Interest Housing Options, what is your preference for Health & Wellness?
Preference for Health & Wellness:
(Click here to choose)
HWRLC is 1st choice
HWRLC is 2nd choice
HWRLC is 3rd choice
HWRLC is 4th choice
HWRLC is 5th choice
HWRLC is 6th choice
HWRLC is 7th choice
HWRLC is 8th choice
Availability of residential rooms in Health & Wellness is limited. To help us determine your level of interest in this community, please respond to the following questions. FIRST-TIME HWRLC applicants please answer questions 1 - 4 only. RETURNING HWRLC members please answer questions 5 - 8 only.
1-NEW APPLICANTS ONLY: What is your personal definition of Health and Wellness? (100 words or less)
2-NEW APPLICANTS ONLY: What do you hope to gain or learn from participating in the Health & Wellness Residential Learning Community? (100 words or less)
3-NEW APPLICANTS ONLY: What contributions will you make toward the goals of health and wellness for yourself and the community? (100 words or less)
4-NEW APPLICANTS ONLY: Please share your interest in exploring and developing a healthier lifestyle and how you have demonstrated (or plan to demonstrate) your commitment to healthier living in the HWRLC. (250 words or less)
5-RETURNING HWRLC APPLICANTS ONLY: How would you describe your ideal health and wellness program?
6-RETURNING HWRLC APPLICANTS ONLY: How would you build upon your first year experience in the HWRLC?
7-RETURNING HWRLC APPLICANTS ONLY: How do you intend to mentor a new HWRLCer or 'give back' to the HWRLC community next year?
8-RETURNING HWRLC APPLICANTS ONLY: What HWRLC-oriented interest areas, skills and passions do you intend to bring to the community next year, and how?
Section 3
HOUSING PREFERENCE QUESTIONS
Wright Hall offers both traditional style housing and suite style housing, mostly in double- and triple-occupancy rooms. More information about room costs and fees can be found at:
http://reslife.uvm.edu/?Page=students/cost/overview.html&SM=students/cost/cost_sm.html
RETURNING/UPPER-LEVEL STUDENTS
:
If you are admitted to Health & Wellness, you will be notified by the Department of Residential Life as to the date and time during which you will be able to go on-line to select your room. Priority for selecting rooms will be based upon your class standing and your room selection lottery number. In order to participate in Room Selection, you must currently be living on campus, and you cannot have a balance due on your student account. For more information about the room selection process, please visit the Department of Residential Life's Website: http://reslife.uvm.edu/roomselection/
NEW STUDENTS
:
If you are admitted to Health & Wellness, staff will place you into a room based upon the preference that you indicate below.
Room size preference:
I prefer a:
(Click here to choose)
Double-occupancy room
Single-occupancy room (If available. Additional charge applies.)
I would accept a single-occupancy room (at additional charge) if all double rooms in this community are full.
Triple-occupancy room (If available.)
If you have a roommate preference, please enter his/her name and UVM ID number here:
Name of Preferred Roommate:
UVM ID Number of Preferred Roommate:
Triple Room Applicants Only - If you have an additional roommate preference, please enter his/her name and UVM ID number here:
Name of Preferred Roommate #2:
UVM ID Number of Preferred Roommate #2:
Disability Housing Accommodation:
Please check here if you will be requesting an ADA housing accommodation through the ACCESS Office. The deadlines for requesting ADA housing accommodations are March 20 for returning students and June 30 for first-year students. Students must renew their ADA accommodation with ACCESS each year. Only those ADA accommodations recommended by ACCESS will be considered.
PARTICIPATION AGREEMENT. By placing my initials below, I acknowledge that I understand that the Health & Wellness Residential Learning Community (HWRLC) is a unique residential/educational community which seeks to integrate formal and informal learning experiences with my residential experience. I understand that the HWRLC needs serious students who are willing to assume responsibility for their own education. I agree that I have read the goals and objectives of the HWRLC (http://www.uvm.edu/rlc/hwrlc) and I pledge to work to support those objectives. If admitted to the HWRLC, I agree to make a commitment of
at least one hour of my time each week
to actively participate in and support Health & Wellness activities. In addition, I understand that every student is required to enroll in a one-credit course that will introduce them to the concepts of the six (6) domains of health and wellness (physical, emotional, intellectual, spiritual, occupational and environmental) through lectures, presentations and a variety of experiential options acquired both in and out of the classroom. I agree that I will enroll in this course unless specific arrangements are made in advance with the Director of the HWRLC. I also understand that Christie-Wright-Patterson is a community of students, faculty and staff who live, learn and work together in a shared environment that includes residential, academic and administrative functions; I agree to be respectful of all members of this community. Finally, I understand that I may be removed from my room and/or relocated to another residence hall if I fail to live up to the terms of this agreement.
Please place your initials here indicating your agreement with the statement above:
Powered by SurveySolutions
survey software