Student Housing Opportunity for Recruitment Enhancement Program — Decision/Information Form

Name:

Primary E-mail Address:

Secondary E-mail Address:

If your address or phone number have changed, please fill in your new information below:

Address (no., street):

(city, state, zip)

Phone:

You will be contacted by the UCSD Residential Services Office when an apartment becomes available close to your desired date for housing. In the event we are not able to contact you due to a change of address or summer travel, please provide an alternate contact who would be able to contact you or act on your behalf. You will receive one housing offer only; therefore, it is very important that you provide your current and alternate contact information.

Alternate Contact Name:

Alternate Contact E-mail:

Alternate Contact Phone Number:

Marital Status (by Move-in date):
Single
Married
Committed Couple — Eligibility Requirements

Sex:
Male
Female

Will children be residing with you?
Yes
No
How many?

Desired date for housing (EXACT DATE NOT GUARANTEED. Housing will be offered up to 2 weeks prior to this date and as late as September 30, depending on apartment availability):
(mm/dd/yyyy)

Please indicate your interest in the Student Housing Opportunity for Recruitment Enhancement Program (SHORE):
Yes, I accept the offer for SHORE
(PLEASE COMPLETE THE ROOMMATE MATCH INFORMATION BELOW. By accepting, I understand that I will be matched primarily with another student of the same gender and similar requested move-in date)
No, I DO NOT wish to accept SHORE (complete RED labeled fields only)
(PLEASE GO TO THE BOTTOM OF THIS PAGE TO SUBMIT)

I have carefully considered my housing options and wish to be a part of SHORE. I understand that a $100 deposit will be required within 10 days of accepting to finalize this offer (Prior to April 15th Option). The deposit should be made payable to UC Regents and sent to:

UCSD Mesa Residential Apartments
9500 Gilman Drive, Mail Code: 0907
La Jolla, CA 92093-0907

I understand that a roommate match is based primarily on gender and requested move-in date. The remainder of the information I provide on this form will be used if there are multiple students with the same criteria. (Inserting your name and date into the spaces below will be considered the same as a signature.)

Name:*

Date:*

Graduate Department:*

Roommate Match Information

Do you smoke?*
Yes
No

Do object to living with a roommate who smokes?*
Yes
No

Do you have a pet?* (Only cats, birds and fish are permitted with additional deposit.)
Yes
No

Do you object to living with a roommate who has a pet?
Yes
No

Would you prefer to live with an individual in your same academic discipline?*
Yes
No
No preference
If yes, what discipline?

Your hobbies are:*

How outgoing are you?*
Extroverted
Average
Shy

You are, in general, a:*
Morning person
Night person

Your neatness, organization, and punctuality are:*
High
Average
Below average

Your study habits are:*
Strict
Moderately strict
Flexible

Describe what you would consider characteristics of a good roommate:*

Additional comments, special needs, special requests: