GORRILL HOUSE APPLICATION FOR RESIDENCE Please complete the Application and submit as directed. No Application Fee is required. Owner will contact you regarding availability of space and procedure for completing Contract. Will you be enrolled in the UC Berkeley Extension Fall Program for Freshman? Yes No Resident Information: Name Birthdate: Gender: Male Female Permanent Contact Information: Address Tel. e-mail Occupancy Preference: Single Double Triple If my preference is not available, I will accept any occupancy: Yes No Roommate Preference (if any) Major / Area(s) of interest Do you prefer going to sleep: Before midnight After midnight Do you prefer getting up: Before 9:00 am After 9:00 am Do you prefer your room to be primarily a place for: Quiet study Socializing Smoking is prohibited on the premises. Do you smoke? I smoke I don't smoke Do your object to a roommate who smokes? I object I don't object May we release your name and phone number to your roommate? Yes No
Please complete the Application and submit as directed. No Application Fee is required. Owner will contact you regarding availability of space and procedure for completing Contract.