Summer Intern Housing Request | University Housing

Summer Intern Housing Request

Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
- Transgender/Non-Binary
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Primary E-Mail Address*

This address will be used for all written correspondence, including confirmations and payment instructions
Intern Housing availability runs from May 16 - August 1, 2020. Extensions are not permitted. Intern stays must be no less than 30 consecutive nights.
Arrival Date*
Date Format: MM slash DD slash YYYY
Departure Date*
Date Format: MM slash DD slash YYYY
Emergency Contact Information*
First Last
Emergency Contact Address Information
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact Phone Number*
Emergency Contact E-Mail Address
Emergency Contact Relationship
Internship Company Name*
Internship Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supervisor Name*
First Last
Supervisor Title*
Supervisor Phone*
Supervisor E-Mail Address*
University Name*
Please provide the name of the University you attend.
University Address*
City State / Province / Region
University E-Mail*

Please provide your university affiliated e-mail address.
Payment Type:*
Comments/Suitemate/ADA Requests
Name & EMail Release*
- Yes
- No
I grant permission for NC State University to release my name and primary e-mail address to my prospective roommates/suitemates for the purposes of making contact prior to our arrival to NC State
Agree To Terms*
- Yes
Do you agree to the following terms: Terms and Conditions