Housing Request

General Information:

* First Name:

Middle Initial:

* Last Name:

Preferred Name:

* Email address:

2nd Email Address (optional):

* Cell Phone:

* Birth Date:

* Gender:

* Program at SRISA:

* Semester/Session at SRISA:

Do you have any physical and/or mental conditions, limitations, or allergies we should know about?

Emergency Contact:

* Emergency Contact:

* Emergency Phone:

* Emergency Email:

Mailing address:[You would you like your housing deposit to be returned to]

* Street Address:

* City:

* State:

* Zip Code:

Indicate 1-5 the adjective that you feel best describes you:

* Neat Freak(1) or Messy(5)?

* Night Owl(1) or Early Bird(5)?

* Outgoing (1) or Reserved(5)?

* Adaptable(1) or High Maintenance(5)?

Housing Request Information:Indicate your Housing Choices

* First Choice:

* Second Choice:

IMPORTANT NOTE: Most accommodations in Florentine apartments are in shared occupancy rooms. We cannot guarantee any student a single room. Those that pay the supplemental single room fee in order to request a single room and are subsequently placed in a shared room will be refunded the difference in price by U.S. check. See here for housing information and costs.

SRISA Shared Student Housing is typically geared towards college aged students. If you are an older participant or have particular living requests, you may want to consider private housing. Read more about SRISA housing on our website or reach out to housing@srisa.org for more information.

Roommate and Housemate Information:Please choose the options you feel best describe your ideal roommate:

* My ideal roommate...

Describe your ideal roommate and/or roommate requests:

Note: We do our best but it may not be possible to accommodate all requests

* I have read and I accept the terms of the SRISA privacy policy disclaimer