Personal Information
Last Name :
First Name:
E-Mail Address:
Date of Birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Semester you will attend:
Select Semester
Spring 2012
Summer 2012
Fall 2012
Housing
Housing Options:
Select Housing Type
Apartment
Homestay
Self-Arranged Housing
Roomate Requests:
Allergies/Medical Conditions that may affect your housing:
Are you a smoker?
Yes
No
Do you wish to live with smokers?
Yes
No
Passport Information
Passport Number:
Passport Expiration Date:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
Authority which issued your passport:
This completes the form. We will use this information
in choosing the best possible housing for you.
After submitting this form you will be returned to the homepage
of the website. There will be no confirmation.