Winter 2019 Airport Pickup Request Form
Complete the form below to request an airport pick-up for the Winter 2019 quarter. If you have any questions or comments, please contact the UCI Student Life & Activities office at or +1-949-824-8530.

Please submit this form at least two weeks prior to your program start date.

The Student Life & Activities office will respond to your request within 72 business hours and will advise if service is approved or denied. Airport pickup requests received less than 2 weeks prior to the program start date cannot be guaranteed and will only be granted based on available space. Cancellation requests and changes must be sent to the Student Life & Activities office at least 48 business hours prior to the pick-up date to be valid for a refund.

**please avoid using & email addresses**

Email address *
Family Name *
*as it appears on your passport
Your answer
First Name *
*as it appears on your passport
Your answer
Gender *
Date of Birth *
Housing *
Program *
Complete this section if this form is being submitted by a representative
Relationship to Student
Educational Agency/Embassy/University Name
Your answer
Contact Name
Your answer
Contact Email
Your answer
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