Professional Education - Short Programs
Request for On-Campus Housing

On-campus housing may only be requested by participants who have enrolled in and paid for an MIT Professional Education - Short Programs course. All applications for housing must be made at least two weeks in advance of the requested arrival date. Housing requests cannot be processed on-site. Please visit the Professional Education - Short Programs site to see the courses being offered. Please note: We urge you to make your reservations early; rooms are booked on a space-available basis.

Before submitting a request, you should review the housing information which is available at: http://web.mit.edu/conferences/www/ShortPrograms/short_dorm_info.html.

Please note: Submission of this request form does not reserve a room nor does it guarantee that a reservation will be held for you. Accommodations will be confirmed, on a space available basis, only when payment in full is received along with the housing request.
Please provide all of the requested information.
Incomplete information will delay your application process.
1. Name & Contact Info - REQUIRED
First Name:
Family/Last Name:
Address 1:
Address 2:
City:
State:
ZIP/Postal Code:
Country:
Phone:
Fax:

Email Address:

 Only one email address should be entered.
2. Arrival & Departure Dates - REQUIRED

The arrival date is the date you check in.
The departure date is the date you must check out of the dormitory by 11:00AM.

Arrival Date

(The earliest check-in date is Monday, June 10, 2013.)

Departure Date

(The last day to check out is Sunday, August 11, 2013.)

Duration of Stay (Count nights, not days)
3. Gender - REQUIRED

Female Male
4. Roommate Information (if any)

Roommate's name:


5. Room Type - REQUIRED

Non Air-Conditioned: Traditional Residence Hall/Shared Bath

Single at $76.00 per night
 Full Double at $100.00 per night*
Shared Double at $50.00 per person, per night**

*Full Double: If you are booking and paying for your roommate, you should request a Full Double.
**Shared Double: If your roommate is sending in a separate request form and payment, you should request a Shared Double.
6. Parking

I would like to request non-refundable parking for (enter number) day(s) at $23.00 per day.
Parking is sold as a package coinciding with the full length of your stay. Your number of parking days should be one more than your number of nights booked.
7. Payment Method - REQUIRED

Online Credit Card Payment (Visa, MasterCard, AMEX, or Discover)
I will be mailing my request with a check in US dollars, drawn on US bank. Please note: Request cannot be processed until check is received.
8. Request - REQUIRED

I understand that submitting this request does not create a reservation. A reservation can only be confirmed, on a space available basis, when payment in full is received along with my housing request and proof of enrollment in a Short Programs course.

Please review your information before submitting request.

NOTE: When you submit this form, if you have not filled in a required field, you will receive an error message alerting you to this. Some Internet Explorer users will only receive a message saying that the page cannot be found. If this happens, use your back key to complete the missing information and re-submit the form.


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