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Application for Summer Housing 2016
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Male
Female
I require specific accommodations. I will contact the Office of Residential Life at
residentiallife@augustana.edu
Phone Number (Best number to reach you)
*
Your answer
Email Address
*
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone Number
*
Your answer
You are ...
*
an Augustana student. (Please skip the next two questions)
a Summer Intern
Required
Summer Interns: Where is your internship this summer?
Your answer
Summer Interns: Who is the contact person at your internship?
Your answer
What dates do you need housing for the summer? (Please note we can only guarantee housing from May 31 - July 31) ie. Month/Day
*
Your answer
We offer single and double bedrooms. Indicate your preference. (Please note: these are 2 bedroom apartments that hold up to 4 students)
*
Single bedroom (Weekly $153.00/Monthly $612.00)
Double bedroom (Weekly $102.00/Monthly $408.00)
Roommate Request
Your answer
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