2011 Summer Catalog - Gallaudet University
2011 Summer Catalog - Gallaudet University
2011 Summer Catalog - Gallaudet University
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gu e s t Ho u s i n g/me A l pl A n Ap p l i c At i o n<br />
<strong>Gallaudet</strong> <strong>University</strong><br />
College of Professional Studies & Outreach<br />
800 Florida Avenue, NE, HMB 141 S, Washington, DC 20002<br />
202.448-7272 (tty/v) 202.651.5987 (fax)<br />
summer@gallaudet.edu summer.gallaudet.edu<br />
Section I: Personal Information (please type or print)<br />
Name: _______________________________________________ Sex: M F<br />
Address: ______________________________________________ Birthdate: __ __/__ __/__ __ __ __<br />
City/State Zip: __________________________________________<br />
MM/DD/YYYY<br />
Phone/Day: (__ __ __) ___ ___ ___- ___ ___ ___ ___ Phone/Evening: (__ __ __) ___ ___ ___- ___ ___ ___ ___<br />
Voice TTY VP Voice TTY VP<br />
Hearing Status: Deaf Hard-of-Hearing Hearing<br />
Email Address: _________________________________________________________<br />
Section II: Requested Accommodations<br />
Requesting dorm housing may not check in and out of the dorms during the duration of their program and are responsible to cover<br />
any days in which they elect to reside off-campus. Students requesting dorm housing are required to purchase an accompanying<br />
meal plan. Meal plans begin the day of the first class at breakfast and continue through dinner the day of the<br />
last class. Additional meals may be purchased upon arrival at one of the campus eateries.<br />
Dorm Housing: $36/night double occupancy (per person)<br />
Dorm Housing: $72/night single occupancy<br />
Meals: $33/day (3 meals)<br />
Linens: $10 (required)<br />
I am requesting on campus accommodations from: _______________________ to _______________________<br />
(MM/YY) (MM/YY)<br />
Please check one:<br />
Housing: $36/double or $72/single x _____nights = $________ + $10 linens = $_________<br />
Meals: $33 days/day X_____days = $_________<br />
TOTAL = $_________<br />
Name of preferred roommate/suitemate: _________________________________________________________<br />
State any physical conditions or dietary restrictions that require special accommodations:<br />
Applying for academic year 20 _____<br />
Semester<br />
Fall Spring <strong>Summer</strong><br />
_________________________________________________________________________________________<br />
Section III: Payment<br />
Please sign and send this Guest Housing/Meal Plan Application with your completed Payment Form to the address above.<br />
Signature: _________________________________________________________________________________________<br />
<strong>Gallaudet</strong> <strong>University</strong> • <strong>Summer</strong> Programs • 800 Florida Avenue, NE; HMB 141 S; Washington, DC 20002 • Tel: 202/448-7272 (tty/v) • Fax: 202/651-5987 33
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