2009-2010 Returning Graduate Student Housing Lottery Application

LOTTERY APPLICATION DEADLINE: Friday, May 1, 2009 by 5:00 p.m.

This form is for returning Caltech graduate students only.  New students should submit the "New Graduate Student Housing Application".  Special students are not eligible.

* INDICATES REQUIRED FIELDS

CONTACT INFORMATION
Gender* Male
 Female
First Name*
Last Name*
Date of Birth*  MM-DD-YYYY
UID (7 digits, omit the leading zeros)*
   

Current Address

Number, Street, Apartment #, etc*
City*
State
Zip*
   
Academic Dept*
Mail Code
Office Ext: (4 digits only)*
Home Telephone
Email*
Retype Email*
APPLICATION STATUS (SELECT ONE)
*Single
*Group List the name of any other applicants you wish to be assigned with.  Check the box to indicate if this is a lottery group application.  All applicants, even if part of a lottery group, must submit their own application.  Groups receive only one lottery number.  Please click here for more information.

          

Is  this a lottery group?
Last First Email Yes      No
Last First Email Yes      No
Last First Email Yes      No
  *Couples: Married or Single with domestic partner. If spouse or partner is also a Caltech graduate student, please submit a separate application for each person.
*Couples with children: Married or Single with domestic partner.  If spouse or partner is also a Caltech graduate student, please submit a separate application for each person.
ENTER THE FOLLOWING INFORMATION (IF APPLICABLE)
Is your spouse a current Caltech graduate student? Yes     No
Spouse/Partner name First
Spouse/Partner name Last
Spouse/Partner Email
Spouse/Partner Date of Birth MM-DD-YYYY
   
Child 1 Name
Child 1 Date of Birth MM-DD-YYYY
Child 1 Gender Male     Female
   
Child 2 Name
Child 2 Date of Birth MM-DD-YYYY
Child 2 Gender Male     Female

HOUSING PREFERENCES

Choices for which you are not eligible will be disregarded.  All Catalina apartments and Avery House rooms come furnished and furniture cannot be removed.  Most off-campus properties are unfurnished.  Please see 2009-2010 Graduate Students On-Campus Housing Rates for specifics on utilities and furnishings included or not included for each option.

List the order of your housing preferences by choosing 1, 2, 3, 4 & 5 from the drop-down menu in the same box as the housing you will accept, with 1 being your FIRST choice and 5 being your LAST choice.

Avery House
$500-$698/bed/month

 Catalina 4-Bed
$525/bed/month

Catalina 2-Bed
$622/bed/month

Catalina 1-Bed
$1,077/month

Off-campus
$525-$1,109/month

Housing Statement (Select One)
I prefer to remain in my current Caltech housing assignment*
I prefer to change my current Caltech housing assignment*
I do not currently reside in Caltech housing*
Specific Location Preference, if any:

PERSONAL PREFERENCES (THIS SECTION IS MANDATORY) - Smoking / Physical Limitations / Allergies
Do you smoke?
(smoking is not allowed in Caltech housing facilities)*		 Yes Outside only No  
Prefer a nonsmoking environment* Yes Outside ok Neutral No
Physical limitations?*
 Yes
 No		 If yes, please explain:
Allergies?*
 Yes
 No		 If yes, please explain:

LIFESTYLE PREFERENCES (THIS SECTION IS OPTIONAL) - If you are single and indicated the Catalina apartments or an Avery double as one of your housing options, check any of the following that you wish to be considered in making your housing assignment.
  Yes Neutral No  
Comfortable with either a male or female roommate
Comfortable if roommate has an overnight guest
Would like to occasionally have overnight guests
Neat and tidy
Wake up early/like quiet at night
Wake up late/like quiet in morning
Comfortable with active social environment in the residence
Vegetarian
Kosher
Other preferences?*
 Yes
 No

 If yes, please explain:

APPLICATION CANCELLATION

You may cancel this application for any reason before Tuesday, June 30, 2009 without penalty. Cancellation notices must be submitted through the online form located on the Graduate Housing website by June 30, 2009.  Room reservation cancellations received after June 30, 2009 will be charged a $150.00 late cancellation fee.  Contracts cancelled on or after September 1, 2009 will result in a $300.00 cancellation fee with a minimum of 15 days notice given.  Please refer to the contract and/or the Intent to Vacate and the Check-out Procedures form for further details.
 

APPLICANT CERTIFICATION

I certify that all statements made on this application are true and complete. I understand that the Housing Policy is to make a fair and reasonable effort to accommodate building choices, roommate requests, and other preferences listed on this application form, but they cannot guarantee any preferences. The Housing Office makes its best effort to match up compatible roommates. I further understand they are not responsible for statements or preferences indicated by other residents that lead to incompatible matches.

By clicking the 'Submit' button, I agree to all of the terms above.