International Student Request for On Campus Housing
International Student Request for On Campus Housing Fall 2006 Residence Hall License/State University of New York at New Paltz Name: ___________________________________________ Last Name First Name Date of Birth: __________/___ _/____ __ Student ID #: Month Day Year Gender: Male Female Room Preference: Corridor Suite Contract Study X 10 Month Hall Program at New Paltz: English Language Program Undergraduate Graduate Exchange Roommate Preference: Last Name First Name Would you like to share a room with an American Student in the CARE Program: _______ Do object to a roommate who smokes? Do you smoke? Please note, if you sign this Residence Hall License a room will be reserved for you and you will be required to live in this room for the entire Fall 2006 semester. Any request for a change must be made in writing to the Director of Residence Life. Please carefully consider your decision before submitting the Residence Hall License. …
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International Student Request for On Campus Housing Fall 2006 Residence Hall License/State University of New York at New Paltz Name: ___________________________________________ Last Name First Name Date of Birth: __________/___ _/____ __ Student ID #: Month Day Year Gender: Male Female Room Preference: Corridor Suite Contract Study X 10 Month Hall Program at New Paltz: English Language Program Undergraduate Graduate Exchange Roommate Preference: Last Name First Name Would you like to share a room with an American Student in the CARE Program: _______ Do object to a roommate who smokes? Do you smoke? Please note, if you sign this Residence Hall License a room will be reserved for you and you will be required to live in this room for the entire Fall 2006 semester. Any request for a change must be made in writing to the Director of Residence Life. Please carefully consider your decision before submitting the Residence Hall License. In consideration of an assignment in a residence hall, I agree to pay SUNY New Paltz the posted room and board charges and I agree to the terms and conditions of occupancy specified in the Housing Handbook, individual Living Unit Rules, College Regulations, Policies of the Board of Trustees, all of which are incorporated herein by specific reference and made part of this agreement. (These documents are provided during new student orientation. If you would like to request a printed copy in advance of your arrival on campus, please contact the Center for International Programs.) Student Signature: Date: Home Address: Telephone Number: Email Address: Please fax a copy of this Residence Hall License to the Center for International Programs at (845) 257-3129. You must also MAIL the original to the Center for International Programs with your Application Response Form. OFFICE USE ONLY OCCUPANCY HALL ROOM TELEPHONE