... for any student wishing to attend ULACIT within an exchange agreement to stay at a Host ... Email: Please answer in
HOUSING REQUEST FORM Date:
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Home University: **Please be aware that our university housing program only manages student’s lodging with Host Families. It is a requirement for any student wishing to attend ULACIT within an exchange agreement to stay at a Host Family. Full Name: Gender: Birth Date: Age: Nationality: Passport #: School Term at ULACIT: From: To: Year: Email: Please answer in full the following questions: This form will help the program coordinators in Costa Rica to accommodate your homestay. Please note that not all requests may be met. Would you mind staying in a house with young children? Yes No Would you mind staying in a house with pets? Yes ________ No __________ If yes, what kind of pets? Are you allergic to: cats dogs birds Others specify: Would you like to share your bedroom with another student? Yes No Do you smoke? Yes No Would you mind living with a family with smokers? Yes ______ No _______ Are you vegetarian? Yes No Do you eat: red meat chicken seafood Do you have any religious beliefs that should be considered before we choose a home for your stay in Costa Rica? Please specify any special physical needs: How would you describe your Spanish language ability? None Intermediate Basic Fluent In case of emergency please notify: Name: Address: Street Home phone: E-mail:
Relationship: City Work Phone:
State
Zip
Note: Please send this form thoroughly filled out to:
[email protected] The information in this document may be verified at any moment during the enrollment process. Illegible forms will be sent back. We advise applicants to fill it out using Microsoft word and print it only to be sibned (this form is expected to be sent in odf format). Please send the following document/ information as soon as you have it: Flight information (arrival & departure)
Your signature: ____________________________________ Housing Request Form
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