Staythrough 2015 FOR OFFICE USE ONLY Application Deadline April 1, 2015 Received on: Student Housing and Hospitality Services Application for on-campus staythrough residence in Lower Cascades for current UBC residents. Last or family name Given or first name My UBC student number is: Assignment Data entered Preferred first name called if different from above Priority Assignment Present room assignment Please attach supporting documentation and indicate if you: Home telephone Alternative telephone  Have a disability. Identify the nature of your disability and the special accommodation required. Please attach/forward a medical certificate (doctor's letter, Email (Residence offer or related correspondence will be sent here.) etc.) to confirm. Regardless of your disability, you INFORMATION RELEASE I request information release as detailed on the Student Housing and Hospitality Service website YesNo http://www.housing.ubc.ca/before-moving-in-okan/before-leaving-home-okan/210 I am: Female Male must be living independently.  My birthdate is: Day / Month / Year Student Status (Documents required with application) Summer student Practicum, from Late finish Day / Month / Year Grad student to Other Day / Month / Year Students will be required to move to their summer room assignment between May 4-5, 2015. Students who will be moving to a residence managed by Student Housing and Hospitality Services in September 2015 are required to relocate between August 22–24. Dates will be confirmed early August. Students not moving to a residence managed by Student Housing and Hospitality Services in September 2015 are required to vacate not later than August 22, 2015. I will require accommodation from April 30, 2013 until: End– Day / Month / Year Roommate Preference If you want to live with specific roommates, you must staple your applications together.. We will use the following information to assign you with a roommate(s) who report similar lifestyle choices, but this is dependent on the space available and we cannot guarantee this will occur. Alcohol Use  I don’t drink alcohol and prefer to live with non-drinkers. Select the one option from each of these categories that best describes you and your habits: Sleep Habits  I am an Early Bird, I usually get up early in the morning   I am a Night Owl, I usually go to bed late at night   Living Space  I keep my living space:    Very tidy  Tidy  Messy from time to time Tidy is not very important to me  In submitting this application I certify that I have read and agree to the application, assignment, charges and refund policies as outlined on our website at http://okanagan.housing.ubc.ca/applications/residence-contracts/, and declare that the information reported on this form is true, correct and complete. I understand that if I am assigned accommodation based on incorrect information, or if my circumstances change, the contract may be terminated by the University and the  Return completed application to: Via mail: UBC Okanagan Student Housing & Hospitality Services 1290 International Mews Kelowna, BC Canada V1V 1V8 accommodation is to be vacated immediately. I understand that application does not guarantee assignment. Via fax: 250-807-9157 Via email: [email protected] Signature Date