International House Reservation Form

See International Student Housing for information about our international houses.

Your contact information

First Name		(Alt+a)
Last Name		(Alt+b)
Address 1		(Alt+c)
Address 2		(Alt+d)
Suite/Apartment		(Alt+e)
City		(Alt+f)
State		(Alt+g)
Country		(Alt+h)
Postal Code		(Alt+i)
E-mail		(Alt+j)
Telephone		(Alt+k)
Fax		(Alt+l)

Your housing request

Which house do you want to reserve? (select) Men's Women's	(Alt+m)
Have you sent the $125 security deposit? (select) Yes No	(Alt+n)
Date you will arrive (mm/dd/yy):	(Alt+o)
What term will you start classes? (select term) Fall (September) Winter (January) Spring (March/April) Summer (June)	(Alt+p)
What year will you start classes? (select year) 2007 2008 2009 2010	(Alt+q)
Length of stay in international house: (select) 1 quarter term 2 quarter terms 1 school year 2 school years Other	(Alt+r)
If other, please explain:	(Alt+s)
If you have questions about housing, would you like to be contacted? (select) Yes No	(Alt+t)

You agree that

	I must send a $125 partially refundable security/damage deposit in advance.	(Alt+u)
	I will sign a Student Housing Contract after I arrive at the college.	(Alt+v)
	I will be required to pay rent for at least one term (approx. 3 months/$900).	(Alt+w)

After submitting, please approve transmission of this form via e-mail. Thank you.

(Alt+x)

Contact International Programs

Laju Nankani, Director
Centralia College
600 Centralia College Blvd.
Centralia WA 98531-4099 USA
E-mail: intl@centralia.edu
Phone: (360) 736-9391, ext. 492
Fax: (360) 330-7503