UIC Campus Housing - Intern Application

Summer Intern Housing Application

*All fields are required

Applicant Info

Email *

Please do not use a ".edu" email address.

First Name *
Middle Name
Last Name *
Address *
City *
State *
Zip Code *
Phone Number *
Gender *
Date of Birth *
What College/University are you affiliated with? *Not UIC
Degree / Group: *
Where will you be interning this summer or what group will you be a part of? (if applicable)
Do you have any physical needs that should be considered when assigning your room?

Arrival and Departure

Choose an arrival date and departure date. Arrivals may be no earlier than May 19th, 2019, and departures may be no later than August 10th, 2019.

Requested arrival date*

Requested departure date*

Emergency Contact

Contact's Name *
Relationship *
Contact's Number *

Additional Services

Cable TV Free! You must provide your own TV and cable cord.
Internet Free! You will be contacted to complete an additional form. You will need to provide your own computer and internet (ethernet) cable.
Additional Notes (if you have a desired roommate put their name and email here)

If approved, you must pay a 10% non-refundable deposit to confirm your reservation.

All payment is due before moving in.