Azusa Pacific University

Department of Leadership and College Student Development
2011 Assistantship Interviews

Assistantship Housing Request
(Housing is available Monday, March 28 to Wednesday March 30)

Name:             
               
               
               
               
               
               
               
   

Address          
      
            
               
               
               
   

E­mail:            
               
               
               
               
               
               
   

Phone: ______________________________________Cell Phone:______________________

____Total nights of housing needed

(3/______Starting night through ­ 3/_______ Last night)

Flight Information
Airline/Flight Number: 
________________________________________________________

Arrival Date & Time:          
               
               
               
               
               
               
               
               
   

Departure City, Date & Time:       
               
               
               
               
               
               
               
   

Pickup needed from Ontario Airport?