PACIFICA GRADUATE INSTITUTE FULL-TIME NON-RESIDENTIAL APPLICATION / HOUSING

This form is to be completed only by students that reside in Santa Barbara or Ventura County.

Students who do not reside in Santa Barbara or Ventura County and still wish to apply for Non- Residential status will need to fill out a separate form (Residential Waiver) and petition their residency status. Please contact Heather Slade at hslade@pacifica.edu for more information.

Students claiming residency in Santa Barbara County or Ventura County must attach proof of residency annually. Proof of residency can include Driver’s license with local address, utility bill, lease agreement, etc. Students are required to notify the Guest Services Coordinator immediately if planning to move outside of Santa Barbara County or Ventura County; as such a move would likely change the student’s residency status.

All forms and proof of residency can be scanned and emailed to Heather Slade at hslade@pacifica.edu or by faxing to 805-879-8270.

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New Student Application

Returning Non-Residential Student

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Program / Track *

Class Level *

New Address? *

Yes

No

Effective Quarter: *

Please indicate the Proof of Residency that you have attached: *

Please attach your proof of Residency *

DIETARY RESTRICTIONS

Student meals are ordered in advance and are served buffet style in the dining room. Three categories of special individual diets are accommodated: vegan, vegetarian and medically restricted diets with an accompanying doctor’s note. Please be advised that additional charges may apply for a restricted diet. Special meals are ordered in advance with this form. If you request special meals, your name, along with special dietary requests, are given to the kitchen staff prior your arrival. Students with special requests are responsible for identifying themselves to the Guest Services Coordinator prior to the meal service on the first day of classes.

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No Dietary Restrictions	Vegan
Vegetarian	Medically Restricted Diet(physicians prescription required)

ADDITIONAL COMMENTS

By signing this document, I agree to the policies put forth by Pacifica Graduate Institute in regard to housing and meals. This includes the procedure of notifying the Guest Services Office in writing OR by email at least five (5) days prior to session of any cancelations OR changes to my housing status, and to be responsible for any charges incurred as a result of a failure to notify the Guest Services Coordinator Heather Slade at hslade@pacifica.edu, in a timely fashion.

Student signature and date: *

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