Conference and Event Services - Summer Housing Application

Name*

First NameLast Name

Gender*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Cell Phone*

Date of Birth*

MonthDayYear

Email*

example@example.com

I'm currently attending the following university/college*

Please explain why you require summer housing (example: I am interning for Acme Corporation and am in need of short term housing)*

My stay is Saint Elizabeth University affiliated*

YesNo

Would you prefer a single suite or single room?*

Single SuiteSingle Room

Will you have a car on campus?*

YesNo

Please attach official documentation proving participation in non-CSE affiliated internship, or courses.*

Company/Institution*

University or College*

Contact Name*

First NameLast Name

Contact Phone Number*

Check here if documentation is not available at this time

Documentation is not available

Emergency Contact Information

Full Name*

First NameLast Name

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Permanent Home Phone*

Cell Phone*

Email*

example@example.com

Relationship*

I will require Summer Housing for the following dates:

Arrival Date*

MonthDayYear

Departure Date*

MonthDayYear

In order to validate my request for accommodation:

*I hereby declare that the information I have provided in this application is accurate to the best of my knowledge.

*I also understand that I am responsible for the policies and procedures stipulated in the Summer Intern Housing Contract

Do you accept these terms?*

AcceptDecline

Check the box and follow the instructions*

If you are experiencing difficulties submitting this application, please call 973-290-4384.