Located On UD Campus

Wilmington: 15 minutes

Philadelphia: 45 minutes

Baltimore: 1 hour

Washington DC: 2 hours

New York City: 2 1/2 hrs

facebook.jpg

Innternationale Reservation Request
Arrival Date *
Please click on your expected arrival date.
Departure Date *
Please click on your expected departure date.

Personal Information
Title
First Name *
Middle Name
Last Name *
Preferred Name * Name you’d like us to call you
Gender *
Date of Birth *
Country of Birth *
Country of Citizenship *
Primary Language Primary spoken language
Other Languages Other Spoken languages

Permanent Address
Address Line 1 *
Address Line 2
City/Town *
State
ZIP or Postal Code *
Country *

Current Address
Only use this section if you are currently living at a temporary address other then your permanent address.
Address Line 1
Address Line 2
City/Town
State
ZIP or Postal Code
Country

Contact Information
Permanent Phone * Residence at Home Country with country/area code
Current / Cell Number If different than permanent phone number
Email Address *

Emergency Contact
Emergency Contact Name *
Emergency Contact Phone * *with country/area code
Relation to above *

Room Preferences
1st Room Preference *
2nd Room Preference *
Floor Preference *
Special Needs *
If answer is other than ‘None’ to above question, please explain

Academic Information
Classification * Note: Freshmen are NOT eligible to apply unless in the ELI program
Major/Degree *
Department/Academic Program * Engineering,Business, Arts & Sciences, ELI Program, Exchange Program etc

Other Information
Medical Needs Explain any medical conditions/needs
Roommate Preference Do you wish to share a room with another INNternationale resident of your choice?
Prefered Roommate (If Yes, Full Name of the person)
Language Preference Do you wish to share a room with a person who speaks a particular language?
Prefered Language (If Yes, Which Language)

Legal
By typing my name below, I certify that I have read and agree to the: Rules and Regulations the Basic Rules and Regulations and the Resident Contract.
Your Signature * (Please Type Full Name)

 
© Copyright 2012 The INNternationale Computer Jocks, Delaware Computer Repair