INTERNATIONAL HOUSING OFFICE            Housing Office notes only:
Umeå University                         Inkom :..................
S-901 87  Umeå,  SWEDEN                 Booknr:..................                 
Phone no: +46 90 7865772                HAfrån:..................
Fax no:   +46 90 7869671                Hyran :..................


HOUSING APPLICATION

Deadline for application: Fall semester May 15. Spring semester Nov 15

Attention: This application is to be filled only by applicant within
exchange programs only ! Please fill in this form completely.
Incomplete or illegible applications will not be processed !


PERSONAL INFORMATION  (Write clearly!)

Last name _____________________________________________________

First name ____________________________________________________
           (given name/names, used name underlined)

Citizenship ___________________________________________________

Date of birth _________________________________________________
              (year-month-day)

Sex :                                |_| Male  |_| Female

Present address _______________________________________________
                (include postal code and Country)

_______________________________________________________________

Present phone number___________________________________________
                    (include aera code no)

Present fax number ____________________________________________
                   (include aera code no)

Present E-mail address ________________________________________



Present address, phone number and e-mail valid until __________

Permanent address _____________________________________________
                (include postal code and Country)

_______________________________________________________________

Permanent phone number_________________________________________
                    (include aera code no)

Permanent fax number __________________________________________
                   (include aera code no)

Permanent E-mail address ______________________________________








(This space only used as a "page break" for printing matters)











ACADEMIC INFORMATION

Home University _______________________________________________

Department of _________________________________________________



The department at Umeå University responsible for my courses/
internship/research: (if more than one underline main department)

Department of _________________________________________________

_______________________________________________________________


Contact person at Umeå University _____________________________


Mark your Exchange Programme :
 
   |_| Bilateral Agreement  
   |_| ERASMUS/SOCRATES
   |_| NORDPLUS/Nordlys  
   |_| Linnaeus-Palme  


Mark your level of study or research:

   |_| Undergraduate
   |_| Postgraduate
   |_| Swedish Institute
   |_| Internship
   |_| Research
   |_| Doctoral work


Intended arrival date in Umeå _________________________________
                              (yy/mm/dd/)

Intended departure date from Umeå _____________________________


Date: ________   Signature : __________________________________


ENCLOSE A PHOTHO !