Pacifica Graduate Institute FULL-TIME RESIDENTIAL HOUSING FORM LADERA CAMPUS-Hybrid Programs

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All students who do not reside in Santa Barbara or Ventura County are considered RESIDENTIAL and are required to reside on campus during each residential session. Three “in-session” nights, with occupancy in the Residence Hall, are included with the quarterly Residential Fee. There is the option to stay additional nights, which are limited to one day prior and/or one day after the session nights. The rate is $89 per night which is billed directly to your student account. There is also an occupancy tax of 10% is charged additionally for non-session nights.

A $ 89.00 charge will incur for a checked non / session night

*Wednesday and Sunday are non session nights.*

Fall

WED

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FRI

SAT

SUN

Winter

WED

THUR

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Spring

WED

THUR

FRI

SAT

SUN

*Summer A separate form will be provided prior to the Summer Quarter.

ROOM PREFERENCES: (Please check all that apply) All rooms are single occupancy, and include shared shower and bathroom facilities on each floor. Please select any preferences you may have below. Please be advised that ALL special room requests are based upon availability and cannot be guaranteed. *

Handicap Accessible Room on 1st Floor

1st Floor - Full Size Bed

2nd Floor - Twin Size Bed

Specific Room Request - Room# (Cannot be guaranteed; based on availability.) Specific Room Request - Room# (Cannot be guaranteed; based on availability.)

ADDITIONAL REQUESTS OR COMMENTS:

Check-in time is 3:00pm or anything thereafter. Check-out time is 11:00 am. A $15.00 late fee will apply if check-out is after 11:00 am.

Housing Policy: All residential students must have a current Residential Housing form on file with the Guest Services Office. All changes must be made in writing. In order to avoid charges, Cancelation must be received at least five (5) days prior to the first day of each class session. If planning to move to Santa Barbara or Ventura Counties, students are required to notify the Guest Services Coordinator. A change to “Non-Residential Status” resulting from a move to Santa Barbara or Ventura counties is made on receipt of the proper documentation and approval by the Housing Committee.

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	Vegetarian
Vegan	Medically Restricted Diet (physician's prescription required)

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 cancellations 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 Nicole Kitzmann at nkitzmann@pacifica.edu, in a timely fashion.

Student Signature: Date: *

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