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This section provides personal information about yourself and your permanent contact details.

Applicant Information

Title:

Family Name:

Given Name(s):

Preferred Name:

Gender:

Date of Birth (d/m/y):

Country of Birth:

Update based on Country of Birth

Nationality (at present):

Country of Citizenship:

Country of Residence:

Marital Status:

Street 1:

Street 2:

City:

State:

Country:

ZIP:

Telephone:

Cell:

Other Phone Number:

E-mail Address:

Note: This email address is required for correspondence.

Address Comments:

Current:

Current Name:

Comments:

Same as Permanent Contact Details

Street 1:

Street 2:

City:

State:

Country:

PostCode:

Home Telephone:

Work Telephone:

Cell:

E-mail Address:

Emergency:

Emergency Name:

Comments:

Same as Permanent Contact Details

Street 1:

Street 2:

City:

State:

Country:

PostCode:

Home Telephone:

Work Telephone:

Cell:

E-mail Address:

College Preferences

Choices of Accomodation

Preference 1:

Preference 2:

Preference 3:

Preference 4:

Preference 5:

Preference 6:

Reasons for Preference:

Please rank in order of preference from 1 to 6 because there are a limited number of private rooms and apartments (1 being first and 6 being last choice).

Year Applying for:

Stay Duration:

What will be your date of arrival?

What will be your date of departure?

Education

Current University, Institution or Program Details

Fill in this section with information related to your studies or program in Philadelphia

Name of Institution / Business

Major:

(eg. 1,2)

Purpose of Visit:

If you have known any previous member, please give details below:

Name:

Year:

Relationship:

(eg. brother, friend etc)

If you have any medical conditions that could relate to your stay at a university college, please give details:

Medical Conditions:

If you have any other Special Requirements or Needs, please give details:

Academic/Business Reference

Reference Details

Reference Name(s):

Telephone:

E-mail Address:

Comments:

Explain in more detail what you will be doing at Philadelphia

How did you hear about International House?

International House Rate Sheet

Accommodations Furnished except for linens, utensils and dishes	Monthly Rates Based on a stay of 3 months or more	Deposit
SINGLE ROOM w/ shared bath	$720	$325
SINGLE ROOM w/ shared kitchen/bath	$780	$325
PRIVATE ROOM w/ private bath, no kitchen	$890	$325
SMALL EFFICIENCY apartment	$995	$450
LARGE EFFICIENCY apartment	$1,040	$450
ONE BEDROOM apartment	$1,250	$450

Semester is any four consecutive months; payment in full (based on short-term rate) due upon move in

Quarter is any three consecutive months; payment in full (based on short-term rate) due upon move in

Deposit is payable by cash, travelers checks, MasterCard, VISA, AMEX, Discover or personal check from a US bank.

Daily and Monthly rates

Accommodations Furnished except for linens, utensils and dishes	Daily/Overnight	Monthly Based on a stay of 1-2 months	Deposit
SINGLE ROOM	$80	$930	$325
PRIVATE ROOM	$100	$1280	$325
APARTMENT	$150	$1280	$450

- Payment in full due upon move in

- Overnight stays payable by cash, travelers check, MasterCard, Visa, AMEX or Discover

- Personal checks are not accepted from overnight guests

Payments due upon arrival at International House

- First month's rent

- Last month's rent (if you plan to stay more than 1 month)

- One time linen charge ($25) includes one (1) set of sheets with pillowcase and towels

- Service�s Fee - $50/$100* - based on length of stay and includes:

International House Programs, use of wireless internet, local phone service, voice mail and access to the Computer Lab and internet ports

*This charge is added each time you renegotiate your housing contract.
- Rates are subject to change at any time.

- Deposits are not refundable once paid unless we cannot accommodate your housing request.

- Rates effective 3/1/09.

Submit Application:

Please submit a $30 processing fee with your application

Disclaimer -- Credit card information is provided at the risk of applicant. International House of Philadelphia assumes no responsibility for the security of transmitting your credit card number via the electronic application. Submission of credit card information optional.

Visa/Mastercard #:

Expiration Date (MM/YY):

Name on Card:

If all the above details are correct, press the Apply button to lodge your application. You will be given an application number, note this number as it can be used for future correspondence.