Email *
Please make sure that you have access to this email. |
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First Name * |
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Middle Name |
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Last Name * |
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Address * |
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City * |
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State * |
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Zip Code * |
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Country |
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Phone Number * |
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Gender * |
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Date of Birth * |
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What College/University are you affiliated with? *Not UIC |
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Please provide Intern Coordinators email address.* |
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Where will you be interning this summer or what group will you be a part of? * |
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Arrival and DepartureChoose an arrival date and departure date. Arrivals may be no earlier than May 18, 2025, and departures may be no later than August 02, 2025. *Please note there is a minimum stay of 7 days |
Requested arrival date* |
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Requested departure date* |
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Residence Hall * |
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If you have a preferred roommate please list their information. |
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Do you have any physical needs that should be considered when assigning your room? If yes, please contact the intern housing office directly. |
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Emergency Contact |
Contact's Name * |
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Relationship * |
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Contact's Number * |
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Additional Services |
Internet |
Free! You will be contacted to complete an additional form. You will need to provide your own computer and internet (ethernet) cable. |
Extended Stay Amenities Available *
Our extended stay amenities package will provide all your kitchen essentials. Save time moving and packing by reserving amenities to use during your stay. In the apartment-style rooms, the $50 extended stay amenities package fee covers:
- Eating supplies (plates, bowls, cups, eating utensils)
- Cooking supplies (pots, pans cooking utensils)
- Coffee maker
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Additional Notes |
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How did you hear about us? |
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A $250 damage and incidental charge will be added to the final bill.
This will be returned to the intern after checkout and room inspection has been completed.
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