NEW STUDENT HOUSING FORM
University of Alaska Fairbanks, Kuskokwim Campus
PO Box 368, Bethel, Alaska 99559
(800) 478-5822 or (907) 543-4500
Name: _____________________________________ Social Security Number: _____________
Permanent Address: ____________________________ Male
____________________________ Female
Permanent Phone: ____________________________ E-mail: _________________________
Emergency Contact: ____________________________ Relationship to Student: ______________
Address: ____________________________
____________________________
Phone: ____________________________
Kuskokwim Campus is committed to equal opportunity for students with disabilities. Please indicate any accommodations you might need.
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Please indicate roommate preference or information that would be of assistance in making room assignments.
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HOUSING DEPOSIT
Kuskokwim Campus requires a $25.00 housing deposit to secure a room in Sackett Hall or the Annex. This deposit is required for the upcoming Fall/Spring semester. Student Services must receive the deposit no later than June 1 for the Fall Semester or December 2 for the Spring Semester. If housing deposits are received after the deadline, Kuskokwim Campus cannot guarantee housing to the student. The fee is non-refundable if you choose not to attend the semester you applied for.
Please circle the semester you need housing for: Fall Spring
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Signature Date
SUBMIT FORM AND $25 DEPOSIT TO STUDENT SERVICES AT THE ABOVE ADDRESS TO SECURE HOUSING!
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