Guest Room Request Application

To reserve the guest room, please complete the application below. For questions about the guest room please contact Travis Warner, Nierling/Wilson Resident Director, at twarner@jc.edu or at (218) 371-6965 or Lori Listopad, Director of Residence Life, at llistopa@jc.edu or at (701) 251-3467 ext. 5453.

Name: *

Arrival Date:

Arrival Time:

:

am

pm

Departure Date:

Departure Time:

:

am

pm

Number of Guests:

Purpose of Visit:

Guest Phone Number:

Guest E-mail Address: *

Campus Contact Name:

Campus Contact Person Phone:

Campus Contact Email: *

For security, please complete the math question.

Math question: * 3 + 7 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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Jamestown, ND 58405

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Email: admissions@jc.edu

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