Internship Housing Request Form

Name:

Address:

City: State: Zip:

Email:

Phone:

Summer Employer:

Male Female

Room Type Requested:
Private Apartment with Single Bedroom and Bath ($200 per week)
Apartment with Single Room and Bath ($150 per week)
Apartment with Double Room and Bath ($100 per week)

If you are requesting a double room and have a specific person with which you would like to room, please list his or her name here:

Check-in Date (earliest available is May 22, 2010)

Check-out Date (latest available is July 31, 2010)

Summer Housing Application