Personal
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| This section provides personal information about
yourself and your permanent contact details. |
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Applicant Information
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| Title: |
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| Family Name: |
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| Given Name(s): |
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| Preferred Name: |
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| Gender: |
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| Date of Birth (d/m/y): |
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| Country of Birth: |
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Update based on Country of Birth |
| Nationality (at present): |
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| Country of Citizenship: |
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| Country of Residence: |
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| Marital Status: |
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| Street 1: |
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| Street 2: |
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| City: |
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| State: |
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| Country: |
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| ZIP: |
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| Telephone: |
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| Cell: |
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| Other Phone Number: |
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| E-mail Address: |
Note: This email address is required for correspondence.
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| Address Comments: |
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Current: |
| Current Name: | |
| Comments: | |
| Same as Permanent Contact Details |
| Street 1: | |
| Street 2: | |
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| State: | |
| Country: | |
| PostCode: | |
| Home Telephone: | |
| Work Telephone: | |
| Cell: | |
| E-mail Address: | |
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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: | |
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College Preferences
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| Preference 1: | |
| Preference 2: | |
| Preference 3: | |
| Preference 4: | |
| Preference 5: | |
| Preference 6: | |
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| Reasons for Preference: |
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| Please rank in order of preference from 1 to 6 because
there are a limited number of double rooms and apartments (1 being
first and 6 being last choice). |
| Year Applying for: |
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| Stay Duration: |
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What will be your date of arrival?
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What will be your date of departure?
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Education
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| Current University, Institution or
Program Details |
| Fill in this section with information related to your studies
or program in Philadelphia |
| Name of Institution / Business |
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| Major: |
(eg. 1,2) |
| Purpose of Visit: |
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| If you have known any previous member,
please give details below: |
| Name: |
Year:
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| Relationship: |
(eg. brother, friend etc) |
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| If you have any medical conditions that could relate
to your stay at a university college, please give details: |
| Medical Conditions: |
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| If you have any other Special Requirements
or Needs, please give details: |
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| Instrument |
| Musical Skills |
| | Interest | Proficiency | Comments |
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| Language |
| Language Skills |
| | Interest | Proficiency | Comments |
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Academic/Business Reference
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Reference Details |
| Reference Name(s): | |
| Telephone: | |
| E-mail Address: | |
| Comments: | |
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| Explain in more detail what you will be doing at Philadelphia |
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| How did you hear about International House? |
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Housing Rates:
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Type
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Long-Term Monthly (8+ Months)
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Short-Term (3-7 Months)
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Semester Rate
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Quarter Rate
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Deposit
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SINGLE w/ shared bath
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$625
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$695
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$2,780
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$2,085
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$325
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SINGLE w/ shared kitchen/bath
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$675
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$755
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$3,020
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$2,265
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$325
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DOUBLE w/ private bath, no kitchen
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$795
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$865
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-
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$325
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SMALL EFFICIENCY apartment
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$895
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$970
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$450
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LARGE EFFICIENCY apartment
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$930
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$1,015
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-
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$450
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ONE BEDROOM apartment
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$1080
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$1,215
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$450
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Daily and Monthly rates
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Type
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Daily/Overnight Rates
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One Month
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Two Months |
Deposit |
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Single Room
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$75
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$900
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$750 - 800
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$325
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Double Room
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$100
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$1,030
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$955
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$325
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Apartment
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$130
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$1,255
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$1,230
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$450
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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.
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