MDIBL: Application for On-Campus Housing

Returning Principal Investigator / New Investigator MDIBL Family Housing

Deadline for a completed application is:

New Investigator Award - January 15, 2008
Returning Principal Investigators - February 1, 2008

INSTRUCTIONS: Please complete and submit this application before the deadline listed above. If you plan on bringing a pet, please print, complete, and submit the pet application, located online and on the Forms and Documents page. This application is also available at MDIBL's Forms and Documents page.

Red asterisks (*) indicate required fields. Completion of all fields marked with an asterisk is necessary for the application to be submitted.

Charles Wray, Ph.D.
Associate Administrative Director
MDI Biological Laboratory
Old Bar Harbor Road (Fed Ex Address)
PO Box 35
Salisbury Cove, ME 04672
207-288-2130 (fax)
207-288-9880 ext 125 (phone)
science_apps@mdibl.org

MDIBL Housing Application - 2008

I. Occupancy Information

First Name*

Middle Initial

Last Name*

Email Address*

Please select your requested period of occupancy*

If you selected an 'other' period of occupancy, please indicate your requested period of occupancy.
Arrival:
Departure:

Please indicate actual dates in residence.*
FROM: TO:

Absences must be indicated PRIOR to cottage assignment. Please list any anticipated absences and responsible adult during applicant's absence.

II. Residents

Please list all others residing in residence (include accompanying spouse, children, and all others).

Name

Relationship

Age

Gender

Dates in Residence

Other (if necessary):

III. Additional Information

Will you require a crib? *

Will you have a pet?

If yes, you must complete a pet application.

Cottage preference. List in order of preference three cottages in which you would like to reside. View cottage information here.

1. 2. 3.

Please list any special needs (ADA accessible, other special needs).

IV. Certification

As of today's date, I certify that all information is correct. I will notify the MDIBL Business Office of any changes.

I agree to pay a $100 deposit fee with the acceptance of housing award and to pay rent in full prior to tenancy unless other arrangements have been made.

I accept the terms and conditions stated above and certify that all the information entered on this form is complete and accurate.*

Applicant:* Date:*