Application for Winter Housing (1/3/16 – 1/24/16)
Pace University offers, at an additional cost of $800.00, limited living arrangements for the inter-session. Housing is limited
for the Winter Term and you might be asked to relocate, therefore, please file this application early! Please note that this is
only the first step in the process and does not guarantee you a room. We will make every effort to accommodate
international students and students who desire campus housing who live outside the Tri-State area. If you have questions,
please call Residential Life at: 914-923-2791 (PLV). Eligibility requirements at bottom of application.
Mr.
Mrs.
Ms. Last Name_______________________ First Name________________________ MI________
University ID Number___________________ Date of Birth_____/_____/_____ Cell Phone #: (
Mo.
Day
)______________
Yr.
On-Campus Address: _________________________________________________________________________________
Res Hall
Room #
Mailbox #
Cell #
Permanent Address:___________________________________________________________________________________
Number/Street
Apt #
City
State
Zip
------------------------------------------------------------------------------------------------------------------------------------------------------Room assignments are multiple occupancy only, based on available space and your responses to the following questions.
This however does not guarantee that you will receive a room assignment that meets your stated preferences.
Preferred Roommate(s):_______________________________________________________________________________
Do you: a.) Plan to work during the inter session?
Yes
No
Full Time
Part Time
b.) Prefer to study with music and/or TV on in your room?
Yes
c.) Describe yourself as:
Socially Active
Moderately Active
Reserved
d.) Describe yourself as:
Meticulous
Neat
Generally Sloppy
e) Go to sleep:
Before 10pm
Before midnight
After midnight
Reason for staying:  Pace Inter-Session Class
 International Student
No
 Varsity Athletic Team
 Other:_________________________________________________________________________________________
----------------------------------------------------------------------------------------------------------------------------------------------------Confidential Information (for our records only) Please indicate any chronic illness/disability (i.e., diabetes, allergies etc.)
________________________________________________________________________________________________ ____________________________
Emergency Contact Name ___________________________________________Relationship_____________________
Home Phone: (
)_________________________________ Business Phone (
)______________________________
Eligibility for Inter-Session Housing (must meet ALL requirements)
-Currently a Resident Student for Fall 2015.
-Full-time undergraduate student of Pace University
-Must be in good financial standing with the Office of Student Assistance.
-Must live outside of a commutable distance from Pleasantville campus (150 miles or more)
-Must be paid in full prior to Check – in.
Return completed application to the Office of Student Assistance along with payment by Decembe9th.
Completion of this form does not guarantee a room assignment.
Office Use Only:
Date Rec’d.___________ Residence Hall_________________
Room_______ MB#________