Summer Housing Application and License Agreement

Application Deadline: Friday, May 1st, 2009 by 5:00 p.m.

Please fill out the form below completely.  Any items marked with an asterisk are required.  Once completed, read the Caltech Summer Guest Housing License Agreement below in its entirety.  After you have fully read this section, you may file your application online by clicking submit.  You will have a chance to review your information before submission.

****IMPORTANT UPDATE – PLEASE READ BEFORE APPLYING FOR HOUSING****
UID Requirements
Our database system is tightly integrated with Oracle (Caltech’s database management system). For security/emergency purposes, ALL visitors (even short-term) must have a UID number before they can be confirmed for housing. If you will be considered part of a Student-Faculty Programs group, you will be automatically issued a UID number. The SURF Office should provide you with the link to the appropriate housing application. If you will NOT be part of a Student-Faculty Programs group, please be sure to contact the professor you are visiting and have them submit the appropriate paperwork to Human Resources on your behalf. In most cases, the professor will have to submit a “Guest Data Sheet” to Human Resources in order for you to be issued a UID number. Our office will not be able to provide accommodations to those that have not been issued a UID number.

Section 1 - Personal Information
1.1 NAME, DATE OF BIRTH, GENDER

Please use same name and email address that you used on the research program application (YOUR FULL LEGAL NAME).
First Name*
Middle Name
Last Name*
Date of Birth*  MM-DD-YYYY
Gender*

Male       Female

1.2 CURRENT ADDRESS
Current Country*
1.3 PERMANENT ADDRESS- Information Same as "Current Address"?  
Permanent State
Permanent Zip
Permanent Country*
1.4 Phone and Email
Email*
Please retype your email*
Primary Phone* numbers and dashes only
Alternate Phone   numbers and dashes only
Please only provide a mobile phone number that will be with you while staying at Caltech in the field below; do not input a landline. It will be used to contact you in cases of a campus emergency through Connect-Ed. Connect-Ed is the information notification system adopted by Caltech in 2007, and is the school’s primary tool of emergency notification.
Mobile Phone   numbers and dashes only
1.5 Emergency Contact
Name*
Phone*
Relationship*

 

Section 2 - Dates of Stay

A four (4) week minimum stay is required. Arrival time is no earlier than 12:00 p.m.-noon on June 16, 2009, or 9:00 a.m. on any arrival date after June 16, 2009. Checkout is no later than 12:00 p.m.-noon on the specified departure date. Please note: Summer housing will only be available between June 16, 2009 and August 22, 2009. NO EXCEPTIONS.
Arrival Date* MM-DD-YYYY
Departure Date* MM-DD-YYYY

 

Section 3 - Caltech/JPL Research Program Information
Program Name
Mentor's Name (Professor)*
Caltech Division / JPL Group
Mentor's Email Address*
Mentor's Phone Number/Extension
Mentor's Mail Code / Stop

 

Section 4 - Housing Rates, Ranks, and Preferences
Please rank the following in order of preference.  Residents will incur an additional $320.00 charge for the Dining Services Meal Plan.
Room Type Rank

Housing Rate Per Month

 Dining Services Meal Plan
North House Double - Loft/Bunk bed, shared bath, community kitchen. NO LINENS* $726.00* $320.00
South House or Avery Single - Lofted bed/desk combos, shared bath, community kitchen. NO LINENS* $800.00* $320.00
South House or Avery Double/Triple - Lofted bed/desk combos, shared bath, community kitchen. NO LINENS* $753.00* $320.00

The housing rates are effective from June 16, 2009 through August 22, 2009.  Rates are subject to change without notice.

*Caltech housing facilities do not include linen. “Linen” refers to sheets, blankets, pillow, towels, etc. Please bring your own or you may purchase them from a local retailer (Macy’s, Ross and Target are all within walking distance to campus) when you arrive. The size of the beds is twin-extra long.

 

Section 5 - Roommate Preferences
Please check all that apply to help us in determining a compatible roommate:

I am a non-smoker

I am a smoker (smoking is not allowed in Caltech housing facilities)

I consider myself a neat and tidy person

I do not consider myself a neat and tidy person.

I prefer quiet in morning (or night-person)

I prefer quiet at night (or early-riser)
Indicate name of preferred roommate, if any:

First Name 

Last Name 

 

Section 6 - Other Information
Indicate any medical conditions affecting room assignments or special emergency evacuation needs due to physical disability:
Additional Comments:

 

Section 7 - Your License Agreement and Submission

 
By clicking on the agree button, you agree to the terms of this License Agreement.