Housing Form

Date: ____/____/_____ Home University: _____________________________

Name: __________________________ __________________________ ________________________ Last First Middle

Gender: ____________ Birth date: ________________ Age: _________

Nationality: ________________________ Passport #__________________________

School Term at ULACIT: From: _____________ to: ____________ Year:______________

E-mail:_____________________________________________________________________________

Please answer in full the following questions: This form will help the program coordinators in Costa Rica to accommodate your home stay. Please note that not all requests may be met.

What type of housing are you interested in?

Host Family ______ Home share ____________ Furnished Apartment _______Hostel _________

Why? _____________________________________________________________________________________

Please fill out the following section only if you’re considering host families/home share as one of your housing options.

Would you mind staying in a house with young children? Yes ______ No______

Would you mind staying in a house with pets? Yes ______ No______

If yes, what kind of pets? _____________________________________________________________________

Are you allergic to cats ___dogs ___birds___ others ___? Specify _____________________________________

Would you like to share your bedroom with another student? Yes ____No____

Do you smoke? Yes ___ No ___ Would you mind staying with a family with smokers? Yes ____No___

Are you vegetarian? Yes ___ No___ Do you eat red meat___ chicken ____seafood____?

Do you have any religious beliefs that should be considered before we choose a home for your stay in Costa

Rica?_____________________________________________________________________________________

Please specify any special physical needs: _______________________________________________________

How would you describe your Spanish language ability?

None _____ Basic _____ Intermediate _____ Fluent ____

In case of emergency please notify:

Name: ____________________________________________ Relationship: ____________________

Address: __________________________________________________________________________ Street City State Zip

Home phone: _________________________ Work Phone __________________________________

E-mail: ____________________________________________________________________________

Your signature: ____________________________________ Date: ______ /______/_______

Note: Please send this form thoroughly filled out to: vcastro@ulacit.ac.cr The information in this document may be verified at any moment during the enrollment process. Illegible forms will be sent back. We advise applicants to fill it out using Microsoft word and print it

only to be signed (this form is expected to be sent in PDF format). Please send the following document/ information as soon as you have it:

Flight information (arrival & departure)