PURDUE UNIVERSITY – FIRST STREET TOWERS GRADUATE HOUSING APPLICATION

(This application, including rates, policies, and other information, is also available on-line at http://www.housing.purdue.edu)
Apply now to establish priority for University housing

Housing application for: Academic Year (2010-2011 Academic Year) Spring Session (January of 2011)
I am accepted as a graduate student for a Master’s □ or Doctoral □ Degree in Department of ______________________________ Gender ______________
Male or Female
Student Identification Number _____ _____ _____ _____ _____ -- _____ _____ _____ _____ _____ Date of Birth ___________/__________/___________
Month Date Year
Full Name Phone Number _
Last First Middle (Area Code)
Current Mailing Address
Street City State / Country Zip Code
Your E-mail Address Your FAX Number
(International students please include country code and city code)
Do you have a medical condition that should be considered in making a room assignment?
Yes_____ No_____ If “Yes,” describe ________________________________________________________________________________________

FIRST STREET TOWERS ROOM ACCOMMODATIONS

METHOD OF PAYMENT FOR HOUSING FEE
Single air-conditioned rooms with private baths are arranged
in clusters around a central living room/dinette area.
(Please note accommodation requirements below.)
Check or Money Order enclosed -- Payable to: Purdue University
You may elect to use Discover, Visa, MasterCard or American Express
MEAL PLAN SELECTION to pay the $100.00 nonrefundable housing fee. Please check card to be
used and complete the required information below:
Meal plans are required at First Street Towers. Select your desired
meal plan below:
____ 10-Meal Plan
____ 12-Meal Plan
____ 15-Meal Plan
Meal Plan information available at
www.housing.purdue.edu
____ 20-Meal Plan
____ Boiler Block Plan ACCOUNT NUMBER EXPIRATION DATE
(month / year)
Billing: Residents of First Street Towers are billed by semester. /
Inquiries:
E-mail: ghapp@purdue.edu
Phone: (765) 494-1000 Authorized signature __

Send Application to: FOR OFFICE USE ONLY

Fax: (765) 494-0718 or Mail to:
University Residences Directors’ Office Room # _______________________________________
Purdue University
Smalley Center Phone # _______________________________________
1225 Third Street Rate _________________ RMS # __________________
West Lafayette, IN 47907-2008

ROOM ACCOMMODATION REQUIRMENTS AT FIRST STREET TOWERS:

*No alcohol will be permitted. *Early Arrival Fees are as follows:

*Smoking is not permitted anywhere in First Street Towers. Room Only: $22.00 per day
*You will be required to take a meal plan. For more information on meal plans offered, Meal Service: 26.00 per day
please visit http://www.housing.purdue.edu/HTML/Dining/MealPlans.htm. Total Room and Board: $48.00 per day
*You will be required to follow the contract start and end dates of the other undergraduate *NO EXCEPTION WILL BE MADE TO CHECK-IN PRIOR
residents living at First Street Towers. The contract start date is Friday, August 20, 2010 TO AUGUST 14, 2010.
and the contract end date is May 8, 2011. You will be permitted to check-in to your room *You will be required to vacate your room at the end of
as early as Saturday, August 14, 2010 and pay early arrival fees through Thursday, the fall semester and prior to Winter Break. You will be
August 19, 2010. able to return to your assigned room on Monday,
January 3, 2011 and have room-only service through
Sunday, January 9, 2011.

I confirm that I will be at Purdue University in student or research status for a minimum of one semester. I understand that if I accept assignment to First
Street Towers, I agree to the accommodation requirements and will be expected to fulfill the terms of the contract as long as I am in student or research status
at the West Lafayette campus.

______________________________________________________________________________________________________________________________
Signature of Applicant Date

AN EQUAL ACCESS/EQUAL OPPORTUNITY UNIVERSITY “Tour our Residences” http://www.housing.purdue.edu