When completing your questionnaire, please fill in as many components as you can (required fields are denoted with a *). This will help us know what direction to take in our search. When requesting long term housing, advance notice is always welcome, but in order to do a true search the renter must be here and ready to pay deposit and first month's rent. Arrival & Departure Date of Arrival: * Year Year201520162017 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Date of Departure: * Year Year201520162017 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Personal Information Title: * - Select -Mrs.Ms.Mr.N/A First Name: * Last Name: * Citizenship: * Coming From: * (University, Lab or Company) Contact Information Email Address: * Telephone Number: * SLAC Information SLAC Affiliation * - Select -EmployeeUserVisitorConsultantInvited Guest SLAC Manager/Host: * SLAC Department/Directorate: Housing Needs Housing Needed for: * - Select -Self onlySelf and others If self and others, please provide additional information below. Name of spouse/companion: Names and ages of children: Are you bringing any pets? * - Select -NoYes Housing Preferences (review ESTIMATED HOUSING COSTS before completing) Maximum RENTAL COST per day (USD): * Maximum RENTAL COST per month (USD): * Note: Utilities are typically not included in rental costs. Type of accommodation preferred: * - Select -ApartmentHouseRoom with limited kitchen privilegesRoom without kitchen privileges Furnished? * - Select -NoYes Number of bedrooms? * - Select -12345 Additional Information Transportation: (Check all that apply) Bicycle Car Car Sharing Notes: 1. Smoking is not allowed in most accommodations. 2. Not all owners are able to accommodate medical conditions. Please let us know should you have special needs. Provide any comments if you have any special needs or requests: