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
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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: ________________________
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͓ Single - $50.75 per night
͓ Double - $33.75 per night
____________________
____________________
___________________________________________
Home Phone
Cell Phone
Email Address
Home Address _______________________________________________________________________________
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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
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Date/Time Received ____________________________________ 5HFHLYHG%\______________________________________