HOUSING APPLICATION FORM

Name:
Date of birth (mm/dd/year): / Passport #
Address:
Telephone: / Email:
Nationality: / First Language: / □ Male □ Female

ARRIVAL INFORMATION: Non-refundable airport pick up fee $150

Arrival date: / Airport pick-up: YES or NO
Arrival time: / Flight #
Airline: / Terminal

HOUSING INFORMATION: Non-refundable housing placement fee $150

School attending: / Check in date: / Check out date:
Number of proposed occupants:
Name: / Relation: / Date of Birth:
Name: / Relation: / Date of Birth:
Maximum Budget:
Accommodation preference (You will be contacted with the availability):
Shared housing Student residence Homestay Private apartment

HOMESTAY REQUEST:

Choose one:
Bed and breakfast(included in price) or Bed, breakfast and dinner(additional $75)
Your occupation: / Hobbies/Interest:
Smoke: Yes or No / Allergies:
Food restrictions:
I prefer a home:
□ with children □ without children □ no preference
□ with other students □without students □ no preference

Emergency Contact Information:

Name:
Relationship:
Telephone:
Address:

The placement fee must be paid with application. Housing rent must be paid minimum 2 weeks prior to arrival. The accommodation application must be received at least 4 WEEKS prior to arrival. If you are applying for a visa, you need to confirm your arrival minimum 2 WEEKS before your arrival date.

PAYMENT OPTION:

Credit CardCardholder’s name______Card type:______

Credit Card #______Expiration date ____/____ /______

ACCOMMODATION REGULATIONS AND GUIDELINES

Cancellations must be received in writing two weeks prior to arrival. If the cancellation is not made two weeks prior to arrival, there will be cancellation fee charge of $250 in addition to the initial placement fee of $150. In case of any postponement or delay of arrival greater than one week with less than two weeks’ notice before the scheduled arrival, a student may be placed in a different home or residence. Students who wish to leave the family or residence must give the Accommodation Coordinator two weeks’ notice. Students who do not give proper notice 4 weeks before leaving the host family or residence will be charged a cancellation fee of $250 and two weeks accommodation fee. Students who wish to extend their stay with a family or in a residence must give the Accommodation Coordinator two weeks’ notice and make payment at the same time. Uceda School is not liable or responsible for any loss, damage or personal injuries incurred during a student’s stay in any of the accommodation. Watch your valuables (jewelry, cash) carefully as Uceda School is not liable or responsible for any monetary losses. Uceda School is not responsible for any misrepresentation or additional arrangements that may be made by any third party or for any dispute that might arise between the student and any party that represents the accommodation.

*Accommodation rates are subject to change without notice.

Student Signature______Date (mm/dd/year) ______

Housing Application Form updated 2/17/15