Summer 2015 Special Guest Housing Application
Summer 2015 Special Guest Housing Application University of Connecticut • Division of Student Affairs • Department of Residential Life Rome Commons, Ground Floor • (860) 486-3430 • [email protected] • www.reslife.uconn.edu This form is for special guests (visiting scholars/students and researchers) who will be sponsored by a UConn professor, department, or college. 7KLVIRUPVKRXOGEHFRPSOHWHGE\WKHVSRQVRULQJGHSDUWPHQWDQGLVGXHEXVLQHVVGD\VSULRUWRDUULYDO GDWHWRDYRLGDODWHIHH 6SHFLDOJXHVWKRXVLQJZLOOEHRIIHUHGIURP0D\3±$XJXVW65RQD¿UVWFRPH¿UVWVHUYHGEDVLV7KHUHLVQRORFDWLRQRU type of accommodation guarantee. Cost is based on available room type ($33.75 or $50.75), and includes linen packet (2 sheets, pillowcase, pillow, 2 towels, and facecloth) with weekly linen exchange. The sponsoring department will be billed via KFS Department/Sponsor Information ___________________________________________ ___________________________________________ Requesting Department Department Head ___________________________________________ ___________________________________________ Sponsor’s Signature Sponsor’s Name Form sent from sponsor’s UConn email account serves as electronic signature ___________________________________________ ___________________________________________ Department Contact Person Email Address ____________________ ____________________ Department Phone U-Box ___________________________________________ Department Fiscal Contact Person/ Dept KFS Guest Information ___________________________________________ ___________________________________________ Arrival Date Departure Date Arrival/departure dates on this form will be the dates the sponsoring department will be charged upon arrival. Changes in arrival/departure dates must be approved by Residential Life and are based on availability. If additional days are added, charges will be adjusted. ___________________________________________ ͓ Female Gender ͓ Male Last Name, First Name Guest Status ͓ Visiting Scholar/Student ͓ Researcher ͓ Other: ________________________ 5RRP7\SH ͓ Single - $50.75 per night ͓ Double - $33.75 per night ____________________ ____________________ ___________________________________________ Home Phone Cell Phone Email Address Home Address _______________________________________________________________________________ 3OHDVHXVHD3&ZKHQVDYLQJDQGHPDLOLQJIRUP7KHIRUPVDUHVXEPLWWHGEODQNZKHQ¿OOHGRXWRQDQ$SSOH Kindly return via email to Rachel Arpin, Housing Assignment Specialist. Alternative return methods are also listed. Email to RDFKHOAUSLQ#XFRQQHGX Save File As - GuestLastName_SpecialGuest.pdf Fax - (860) 486-6191 Attn: Rachel Arpin Mail Rachel Arpin Department of Residential Life 626 Gilbert Road Extension Unit 1022 Storrs, CT 06269-1022 5HV/LIH2I¿FH8VH2QO\ Date/Time Received ____________________________________ 5HFHLYHG%\______________________________________
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