International Student Request for On Campus Housing 
Fall 2006 
Residence Hall License/State University of New York at New Paltz 
 
 
 
Name: ___________________________________________ 
 
   Last Name                                             First Name  
 
Date of Birth: __________/___  _/____   __      Student ID #:   
 
 
 
 
 
 
                      Month                  Day             Year      
 
Gender:  … Male   
… Female 
 
Room Preference:  … Corridor  … Suite 
… Contract Study 
X 10 Month Hall 
 
 
Program at New Paltz:  … English Language Program 
… Undergraduate 
… Graduate 
… Exchange 
 
Roommate Preference:  
 
 
 
 
 
 
 
 
 
 
 
 
 
Last Name First Name 
 
Would you like to share a room with an American Student in the CARE Program:  _______ 
 
Do object to a roommate who smokes?  
Do you smoke?  
 
 
 
Please note, if you sign this Residence Hall License a room will be reserved for you and you 
will be required to live in this room for the entire Fall 2006 semester.  Any request for a change 
must be made in writing to the Director of Residence Life.  Please carefully consider your 
decision before submitting the Residence Hall License. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In consideration of an assignment in a residence hall, I agree to pay SUNY New Paltz the posted room and board charges 
and I agree to the terms and conditions of occupancy specified in the Housing Handbook, individual Living Unit Rules, 
College Regulations, Policies of the Board of Trustees, all of which are incorporated herein by specific reference and 
made part of this agreement.  
 
(These documents are provided during new student orientation.  If you would like to request a printed copy in advance of 
your arrival on campus, please contact the Center for International Programs.)  
 
 
 
Student Signature:  
 
              
 
 
   Date:   
 
 
 
 
Home Address:  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Telephone Number:  
 
 
 
   Email Address:   
 
 
 
 
 
 
 
 
Please fax a copy of this Residence Hall License to the Center for International Programs at (845) 257-3129.   You 
must also MAIL the original to the Center for International Programs with your Application Response Form. 
 
 
 
OFFICE USE ONLY 
 
 
OCCUPANCY 
HALL 
ROOM 
TELEPHONE