pre-college summer art experience campus housing application …

        pre-college summer art experience campus housing application

    campus housing requiremenTs                           Tell us abouT yourself ­ roommate compatIbIlIty

    n      must stay for duration of the
                                                          Gender                                           n   female       n   male
           pre-college summer art experience program
                                                          name of High school
    n      $500 security deposit (refundable)
                                                          Grade entering in fall
    n  ousing students must be enrolled in four (4) art
      H
      experience classes. (non-applicable to daily-rate
                                                          special accommodaTions
      students.)
                                                          I require an extra-long bed                           n yes      n   no
    n      Housing license agreement (terms &
           conditions, and rules & regulations agree-
           ment) must be submitted after application      emergency informaTion


    i am applying To housing for:
                                                           HealtH Insurance co.                             Insurance #
        nsummer                 year:

                                                          emergency conTacT #1
    all informaTion musT be compleTe                      (It is permissible to release all relevant information to this person in the
                                                          event of an emergency.)


     last name
                                                           last name                                        fIrst name



     fIrst name                                   m.I.     street address




                                                           cIty                                state                        zIp
     street address



                                                           (area code)   Home pHone
     cIty                                  state


                                                           (area code)   cell pHone

     zIp                        country
                                                          emergency conTacT #2
                                                          (It is permissible to release all relevant information to this person in the
                                                          event of an emergency.)
     emaIl address

                                                           last name                                        fIrst name

     (area code)   Home pHone number

                                                           street address


     (area code)   cell pHone
                                                           cIty                                state                        zIp



     bIrtHday (montH / date / year)
                                                           (area code)   Home pHone


   If you have any questions regarding the application
   process, please contact the                             (area code)   cell pHone

   housing department
   1.800.544.2787 or housing@academyart.edu
                                                            for academy use only: Id #

(PCSAE Campus Housing Application, page 1 of 2)
     pcsae students are automatically assigned to rodin                paymenT summary
     dormitory or International House. Housing is guaranteed
     to all students, although the academy cannot guarantee
                                                                       1.     option a: summer art experience special Housing package
     placement in a specific building or room type.
                                                                                                                         $2,550.00
                                                                              or
     raTe cosTs

                                                                       2.     option b: summer art experience daily rate
     opTion a:
                                                                              (maximum 3 night per week) number of nights
     summer arT experience special housing package*
                                                                              spent during the 6 week program x $60 =     $
     6.5 Weeks - $2,550
     summer art experience housing is available for the full 6.5
                                                                              and
     weeks of the program at a cost of $2,550, which includes
     housing and three meals per day, monday through friday, and
                                                                       3.     security deposit:                                           $ 500.00
     brunch and dinner on saturday and sunday at the café rodin
     or the iHouse diner. as an additional benefit, students living
     in campus housing take four summer art experience classes,        Total payment enclosed (1 + 3 or 2 + 3)                            $
     rather than two, and enjoy an array of school-run activities.


     opTion b:
     summer arT experience daily raTe*                                 paymenT meThod : (cHoose one)
     $60 per nighT
     summer art experience housing is available at a daily rate of
                                                                       npersonal check
                                                                              (make check payable to: academy of art university)
     $60 per night, which includes three meals per day, monday
     through friday, and brunch and dinner on saturday and sunday      nmaster card                nVisa
     at the café rodin or the iHouse diner. the daily rate is conve-
     nient for students who stay in san francisco for the two days
     of classes then return home for the remainder of the week. a       credIt card number
     maximum of three nights per week applies for the daily rate.
     nights booked and paid for which are not used are non-re-
     fundable and non-transferable.                                     name of cardHolder
                                                                                                         $
     * all applicants will be required to sign the terms and
       conditions, rules and regulations outlined in the Housing        expIratIon date (mm/yy)          amt. to be cHarGed on my card
       license agreement.


     securiTy deposiT
     a security deposit of $500.00 is required with the Housing         sIGnature of cardHolder                                    date

     license agreement. the security deposit is fully refundable
     less the building mandatory maintenance charge of $75.00
     and any other fines or charges incurred provided the room
     is vacated in the condition in which it was found and all
     inventoried equipment provided in the unit room is accounted      I certify that all information presented in this application is true
     for. these charges will be automatically deducted from the        and correct to the best of my knowledge.

     security deposit.


                                                                            applIcant's sIGnature                              date
     please make sure you do The folloWing:

     step 1          n fill out this application completely            parent signature required for students under 18.


     step 2 n read and sign Housing license agmt.
             
             ·Terms&ConditionsAgreement                                 parent sIGnature                                       date
             ·Rules&RegulationsAgreement 

     step 3          n mail payment and all forms to:                  parent signature required for dependent students over 18.


                           academy of art university
                           housing office - pcsae program               parent sIGnature                                       date
                           79 new montgomery st., 3rd floor
                           san francisco, ca 94105
                                                                       note: If the student is under eighteen (18) years of age or a
                                                                       dependent student over 18 years of age; upon signing of this
     please sign all forms and return to the Housing depart-
                                                                       contract, his/her mother, father, court appointed legal guardian,
     ment as soon as possible. upon receipt, your dorm/apart-
                                                                       or co-signer must guarantee the student's obligation pursuant
     ment and room assignment will be made. your requests
                                                                       to this contract by signing above. notice to co-signer: In the
     will be honored on a first come, first serve basis.
                                                                       event of the student's default, you will assume responsibility for
     these forms can also be found on the academy's website
                                                                       payment in full plus any applicable charges as indicated in the
     at www.academyart.edu.
                                                                       residence rate table.

(PCSAE Campus Housing Application, page 2 of 2)