Pacifica Graduate Institute FULL-TIME RESIDENTIAL HOUSING FORM Lambert Campus-Clinical

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Three “in-session” nights with double occupancy at the Best Western Carpinteria Inn are included with the quarterly Residential Fee. Housing requests other than the “in-session” nights will incur additional charges. Single room requests and/or additional nights (limited to one day prior and/or one day after session) are optional and are billed in accordance with the rates listed under optional services and fees.

Please check the nights of stay at the Best Western: (Occupancy tax is included.) You may fill out the housing form on a quarterly or annual basis. A charge will be billed to your student account for any additional nights

A $ 97.90 charge will incur for a checked non-session night

*Wednesday and Sunday are non session nights*

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

OPTIONAL SERVICES AND FEES:

All rooms at the Best Western Hotel are double occupancy and shared with another student in your cohort, unless a single occupancy room is selected at an additional fee. If your request cannot be honored you will be contacted by the housing department prior to your arrival.

Please mark your request below.

OPTIONS: *

Single Occupancy (in-session/per night $42.00 and non-session/per night $131.00)

Special Room Request (Courtyard Room per/night $25.00)

Double Occupancy (non session per/night $97.90) Roomate Preference Double Occupancy (non session per/night $97.90) Roomate Preference

ADDITIONAL COMMENTS:

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.

No Dietary Restrictions	Vegetarian
Vegan	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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