2009–2010 APPLICATION FOR CRONKHITE CENTER GRADUATE STUDENT HOUSING
Cronkhite Center, Radcliffe Housing Office, Radcliffe Institute for Advanced Study, 84 Brattle Street, Cambridge, MA 02138 Your application will not be processed unless all fields are complete AND the $75 non-refundable fee (check made payable to Radcliffe Institute) and photograph are included. The photograph will be used for a student face map for residents. Please print all answers in ink and return by 3 p.m. EST on Thursday, April 30, 2009. Last Name: Date of Birth: _______/_______/______ (month / day / year) E-mail Address: (must be valid through 8/31/09) School: GSAS GSE GSD HDS HKS First Name: Sex: M F Middle Initial: Country of Citizenship: Telephone: EdD Masters Special Student Fellow First Year Graduate Student? Y N Preferred First Name:
Fax Number: Program: PhD
Harvard ID Number (if known) ________________________ Current Mailing Address:
Undergraduate Institution and Graduation Date (month/year)
STUDENT’S PERMANENT ADDRESS IN CASE OF EMERGENCY PLEASE NOTIFY _____________________________________
CRONKHITE HOUSING OFFICE USE ONLY
1. Name:________________________________________ Date Application Received:_____/_____/_____ Telephone:______________________________________ _____________________________________ Check Number: ___________________________ 2. Name:________________________________________
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Telephone:______________________________________ Photo Received: ____________________ PLEASE NOTE: THE CRONKHITE CENTER IS A NON-SMOKING BUILDING. Please identify any physical disability or other medical condition which necessitates special accommodation. Additional documentation may be required. Please contact the Radcliffe Housing Office for information about wheelchair access and other disability concerns.
Please rank in order of preference ALL accommodations you would accept. Price per person per year $7,838 $9,555 $8,646 $10,642 Accommodation type Small Single Premium Single Bedroom in two-bedroom suite, plus bathroom and common room Bedroom in large three-bedroom suite, plus bathroom and kitchen/common room (1 available) Choice (please rank)
In addition to the room fees listed above, there is a mandatory board fee of $4,530 and a mandatory activity fee of $50. NOTE: YOU MUST BE A FULLY ENROLLED, REGISTERED DEGREE CANDIDATE STUDENT WHO WILL BE TERM-BILLED TO APPLY TO CRONKHITE.