Bard NYC Housing Application

Please complete this form to apply for housing at the Bard NYC Williamsburg Residence.

1Personal Information > 2Emergency Contacts > 3Room Assignment
Name Name First Last
Current Institution of Study
Degree Program
Expected Graduate Date (MM/YYYY)
Date of Birth Date of Birth / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Phone - ### - ### ####
International Phone
Will you be taking classes towards your degree while living at Bard NYC Residence?

Will you be taking classes towards your degree while living at Bard NYC Residence? Yes No

If you selected Yes, you do not need to complete the four internship questions below.
If no, will you participate in an internship which provides beneficial learning while at Bard NYC and are you registered to resume your studies at your home institution following your internship?

If no, will you participate in an internship which provides beneficial learning while at Bard NYC and are you registered to resume your studies at your home institution following your internship? Yes No
Internship Organization
Dates of Internship
Start date of your next term of study (after planned completion date of your internship).
I certify that I am (or I am reserving on behalf of someone) currently enrolled as a student or will be enrolled as a student prior to move-in to Bard NYC and will be taking one or more courses during my stay at Bard NYC.

I certify that I am (or I am reserving on behalf of someone) currently enrolled as a student or will be enrolled as a student prior to move-in to Bard NYC and will be taking one or more courses during my stay at Bard NYC. Yes No
I certify that I am (or I am reserving on behalf of someone) a student who will be interning for beneficial knowledge while in New York City and will resume my studies following the completion of my internship.

I certify that I am (or I am reserving on behalf of someone) a student who will be interning for beneficial knowledge while in New York City and will resume my studies following the completion of my internship. Yes No

If you select no to both of these certifications, you are not eligible to stay at the Bard NYC Residence.
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