pre-college summer program campus housing application …

        pre-college summer program campus housing application

    campus housing requiremenTs                                        Tell us abouT yourself

    · Must stay for duration of the                                    Gender                                            Female              Male
      Pre-College Summer Program
    · $500 Housing Deposit (Refundable)                                Name of High School
       ($75 deducted for building maintenance fees)
                                                                       Grade entering in Fall
    · Housing students must be enrolled in four (4)
      Summer Program classes. (Non-applicable to
      Daily-Rate students.)
                                                                       special accommodaTions needed:

                                                                       If yes, please detail:
   sTudenT id number (If Available):

                                                                       emergency informaTion
    i am applying To housing for:


            Summer              Year:                                   HeaLtH INSuraNCe Co.                             INSuraNCe #

    all informaTion musT be compleTe
                                                                       emergency conTacT #1
                                                                       (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


     Street addreSS
                                                                        CIty                                State                        zIp



     CIty                                       State
                                                                        (area Code)   HoMe pHoNe



     zIp                        CouNtry                                 (area Code)   CeLL pHoNe


                                                                       emergency conTacT #2
                                                                       (It is permissible to release all relevant information to this person in the
     eMaIL addreSS
                                                                       event of an emergency.)




     (area Code)   HoMe pHoNe NuMber                                    LaSt NaMe                                        FIrSt NaMe




                                                                        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
   housing department 1.800.544.2787 ext. 6335                          (area Code)   CeLL pHoNe
   or housing@academyart.edu

(Pre-College Summer Program Campus Housing Application, page 1 of 2)
     residence assignmenTs                                             paymenT summary

     Pre-College Summer Program students are automatically             Please choose Option A or Option B and enclose the appropriate amount.
     assigned to the building selected for the program.
     Housing is guaranteed to all students, although the               option a: Special Housing Package Rate               $2,550.00
     Academy cannot guarantee placement in a specific                                                                   +    $500.00 Housing Deposit
     building or room type.
                                                                                                                        = $3,050.00 TOTAL
     raTe cosTs                                                        or

                                                                       option b: Daily Rate
     opTion a:
                                                                       Number of nights in housing
     pre-college summer program
                                                                       (maximum 3 nights per week for 6 weeks) =                        No. of Nights
     special housing package                                                                                     x           $60.00     Nightly Rate
     6.5 Weeks - $2,550
     Pre-College Summer Program housing is available for the full                                                = $                    Housing Cost
     6.5 weeks of the program at a cost of $2,550, which includes
                                                                                                                 +          $500.00     Housing Deposit
     housing and three meals per day, Monday through Friday, and
                                                                                                                 = $                    TOTAL
     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 Pre-College Summer Program
     classes, rather than two, and enjoy an array of school-run
                                                                       paymenT meThod : (CHooSe oNe)
     activities.
                                                                            personal Check
     opTion b:                                                              (Make check payable to: Academy of Art University)
     pre-college summer program daily raTe                                  Master Card              Visa
     $60 per nighT
     Pre-College Summer Program housing is available at a daily
     rate of $60 per night, which includes three meals per day,
     Monday through Friday, and brunch and dinner on Saturday           CredIt Card NuMber
     and Sunday at the Café Rodin or the iHouse Diner. The daily
     rate is convenient for students who stay in San Francisco for
     the two days of classes then return home for the remainder         NaMe oF CardHoLder
     of the week. A maximum of three nights per week applies for
                                                                                                       $
     the daily rate. Nights booked and paid for which are not used
     are non-refundable and non-transferable.                           expIratIoN date (MM/yy)        aMt. to be CHarGed oN My Card




     housing deposiT                                                    SIGNature oF CardHoLder                                  date
     A Housing Deposit of $500.00 is required with the Housing
     Application. The deposit is fully refundable less the build-
     ing 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     I certify that all information presented in this application is true
     provided in the unit room is accounted for. These charges will    and correct to the best of my knowledge.
     be automatically deducted from the Housing Deposit.


                                                                         appLICaNt'S SIGNature                                date

  please make sure you do The folloWing:
                                                                       Parent signature required for Students under 18.
  step 1           n   Fill out the pre-college summer
                       program campus housing
                       application Completely                           pareNt SIGNature                                      date

  step 2           n   Send $500 Deposit Payment and
                       application to:                                 Parent signature required for Dependent Students over 18.

                       academy of art university
                       housing office - pre-college program
                       79 New Montgomery Street, 1st Floor              pareNt SIGNature                                      date
                       San Francisco, CA 94105
                                                                       NOTE: If the Student is under eighteen (18) years of age or a
                       After the Academy receives your
                                                                       Dependent Student over 18 years of age; upon signing of this
                       Housing Application, you will be emailed:
                                                                       contract, his/her mother, father, court appointed legal guardian,
                       · Terms & Conditions Agreement
                       · Rules & Regulations Agreement                 or Co-Signer must guarantee the Student's obligation pursuant
                                                                       to this Contract by signing above. Notice to Co-Signer: In the
  step 3           n   Review, sign and return the forms               event of the Student's default, you will assume responsibility for
                       promptly to secure your Campus Housing.         payment in full plus any applicable charges as indicated in the
                                                                       Residence Rate Table.

(Pre-College Summer Program Campus Housing Application, page 2 of 2)