Student Housing Request
Please provide as much information as possible so we can make the best match possible. It is important to understand that we will make every effort to honor your requests, but cannot make any guarantees. For questions, contact: sales-info@churchillliving.com.
University Name/Location:
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
WhatsApp Number (If applicable)
Please enter a valid phone number.
Arrival Date
-
Month
-
Day
Year
Date
Departure Date
-
Month
-
Day
Year
Date
Program/Semester:
Gender
Please Select
Male
Female
Vegetarian?
Please Select
Yes
No
Wheelchair Access Needed?
Please Select
Yes
No
Smoker?
Please Select
Yes
No
(All Churchill Living Apartments are non-smoking)
Service Animal?
Please Select
Yes
No
Will you need a parking space?
Please Select
Yes
No
Do you have a roommate in mind you'd like to room with?
Full Name
1
2
3
Do you have an Agency/Sponsor? If so, please provide the following information:
Business Full Name
Contact Person Full Name
Contact Person Email
example@example.com
Comments:
Submit
Should be Empty: