_ -----OFFICE USE ONLY
Date
Received:
___Receipt:___
Unit Assignment:___________
Unit Type:________________
Campus: UP __ NC __ PH __
HOUSING APPLICATION

Please complete all the information requested and return this application with a $150 deposit to: FIU, University Housing Office, University Park, Miami, Florida 33199. Funds must be drawn on a U.S. Bank. Checks, money orders or travelers checks only. ____NO CASH OR CREDIT CARDS ACCEPTED.

INFORMATION
Gender: Male__ Female__ Date of Birth __/__/__ Have you ever applied for FIU Housing? Yes__ No__	
HOUSING REQUEST FOR:
__ Academic Year 19 (Fall/Spring)  __ Spring 19___Term   __ Summer 19___ A / B (Please circle)
Name:___________________________________________________    SS/Student#:______________________     
Address:________________________________________________     TEL #:(    )_____________________
________________________________________________     FAX #:(    )_____________________ 	
School Enrollment:  FIU___    Other(Specify):_________________________________________________   
Classifications:  FR__  SO__  JR__  SR__  GR__  Major________________________________
Participating in Florida Prepaid College Program _____
Health problems or handicaps which may require special accommodations (Describe)______________
LIVING OPTIONS
UNIVERSITY PARK APARTMENTS & NORTH CAMPUS: Married Housing: ___
UNIVERSITY PARK APARTMENTS: Graduate Housing ___
UNIVERSITY PARK PANTHER HALL: Honors and Scholars Wing ___
(for Honors College & Academic Scholarship students)
F.Y.R.S.T. (First Year Residents Succeeding Together) ___
(requires supplemental application, Freshmen only)
If space is available, I would prefer the following type of assignment: (Number in order of preference)
.. ..North Miami Apartments ,University Park Apartments Panther Hall
__ A- Studio/Single __ F - Studio/Single __ Two Bedroom
(
--)Single (--) Double
__ B - 1Bedroom (private bath)
(--) Single (--) Double
__ G - Efficiency
(.. )Single (..)Double
--------
__ C - Efficiency/Single (shared bath) __ H - 1 Bedroom/Double
-__ D - 1 Bedroom (shared bath)
(
.. )Single( .. )Double
__ I -- 2 Bedroom
(
--) Single (--) Double
__ E. - 2 Bedroom/Double (shared bath)
(V )Single ( .. )Double-
__ J - 2Bedroom/Double-
__ K - 4 Bedroom/Single
If space is available, I would like to room with the following (only mutual requests will be honored).
Please state Name and SS#. If married, please provide spouse's name below. Note that children are not
eligible for housing.
1._____________________________________________  3.______________________________________
2._____________________________________________  4.______________________________________
I understand that this is an application for housing space at Florida International University and not an application
for a certain type of space or a specific building. While every effort will be made to use preference in issuing a
Housing Agreement, all offers will be based on space Available. I have read and understand the information provided.
Signature_______________________________________    Date_________________________________ 

| Application Forms |