Housing Request Form

SPRING INTERNATIONAL LANGUAGE CENTER

Housing Request Form

Attention: Student Services Coordinator

You can print this housing request form from MS Internet Explorer. If you are not able to print this form, please send us an e-mail message at silc@uark.edu and we will mail or fax you this request form as soon as possible.

This form must be returned before we can arrange your housing. Please print this out, complete it, and return it with your application.

I am applying for: 

[ ]Off-campus SILC apartment [ ]International Living Residence Hall (Holcombe Hall) 

[ ]Homestay (limited availability)   [ ] I will find my own housing

Session I plan to attend: ______________ Date I plan to arrive: ____________

Surname: __________________________ First Names: ___________________________
(Family)                                 (Given names)

Home Address: ______________________________________________________________

____________________________________________________________________________

E-Mail: __________________________________ Telephone: ______________________ 

Fax Number: __________________ Birthdate: ___________ [ ]Male [ ]Female
                                         month/day/year

If you are working, please list your company and your position:

____________________________________________________________________________ 

Have you attended a university? [ ]Yes [ ]No  Area of study?:_______________

English Speaking Ability: [ ] Very good   [ ] Good   [ ] Fair  [ ] Poor


PERSONAL INFORMATION

    •List foods you do not like or cannot eat: _____________________________
    •List any special health problems (allergies, handicaps, etc.):

     _______________________________________________________________________

    •Do you smoke? __Yes __No If YES, would you smoke outside? __Yes  __No

                
Your Interests and Hobbies (check the ones that are true for you):

                
___reading   ___movies  ___shopping  ___dancing  ___the arts  ___soccer

___swimming  ___skiing  ___cycling   ___baseball  ___tennis  ___camping

___travel - countries you have visited: ___________________________________

___music - types of music: ________________________________________________ 

___musical instruments that you play: _____________________________________ 

•Other interests: _________________________________________________________ 


Personal Characteristics (check the ones that are true for you):

___independent  ___cautious  ___quiet     ___talkative  ___serious

___tidy         ___studious  ___humorous  ___energetic  ___sociable/outgoing 
 
•Other characteristics ____________________________________________________ 

•If you chose homestay, do you prefer to stay in a family with children?

 ___ Yes. List ages you like the most _____________________________________ 

 ___ No. List ages you do NOT like ________________________________________

 ___ It's not important.

•Would you like to stay with a family that has animals?

 ___ Yes. List animals you like: __________________________________________ 

 ___ No. Check the animals you do NOT like: ___cats ___small dogs

         ___big dogs ___birds  ___reptiles  others: _______________________

 ___ It's not important. 

Please list any special requests or special concerns that you have
about your homestay or apartment placement:

___________________________________________________________________________

___________________________________________________________________________


Have you ever lived with an American family before? ____Yes   ____No

•If YES, describe your experience: ________________________________________

___________________________________________________________________________

___________________________________________________________________________

Describe yourself and your own family:_____________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Do you have any friends or relatives in the United States? Please list
their information below: 

Name: _________________________________________ Phone: ____________________

Address: __________________________________________________________________

E-mail address: ________________________________ Fax: _____________________

Thank you for filling out this form. Please return it in the same envelope with your application form to:

Spring International Language Center
300 Hotz Hall
University of Arkansas
Fayetteville, AR 72701

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SPRING INTERNATIONAL LANGUAGE CENTER Housing Request Form Attention: Student Services Coordinator

SPRING INTERNATIONAL LANGUAGE CENTER

Housing Request Form

Attention: Student Services Coordinator