Date of Departure

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2011 2012 2013 2014 2015 2016 2017 2018 Time AM PM

Personal Information

First Name:

Family Name:

Gender:
Choose one Male Female

Citizenship:

Coming From (University/Lab or Company):

Contact Information

Email Address:

Telephone Numbers:

Office:
Home:
Cell:
Fax:

SLAC Information

Your new job title at SLAC:

SLAC Manager:

SLAC Department/Group:

Housing Needs

Housing Needed for:
Choose one Self Only Self and others (See below)

Name of spouse/companion:

Names, ages, and gender of children:

If you are bringing your pet(s), please give us the name(s) of your pet(s) and describe the type, breed, height, weight:

Housing Preferences
      Review ESTIMATED HOUSING COSTS before completing

Maximum Price Per Day  $:

Maximum Price Per Month $:
 

Type of accommodation preferred: Choose one Stanford Guest House (on SLAC site) Hotel Room w/limited kitchen privileges Room without kitchen privileges House Apartment

Furnished     
Unfurnished

Number of bedrooms: 

Additional Information

Transportation: (Check all that apply)
  Car
Car Sharing (list names below):
Bicycle
None         Car Sharing With (provide names)

Do you smoke? 
No
Yes

Do you have any allergies?
No
Yes

If yes, please provide us more information:

Provide any comments or special requests in the below: