International Exchange Student Housing Application

General Information

First/Given Name

Family Name/Surname

Birthdate

Gender

Email Address

Street Address

Street Address Line 2

City

State/Province/Region

Postal/Zip Code

Country

FOR STUDENTS UNDER THE AGE OF 18 as of Aug. 31, 2015: The undersigned parent/guardian of the named student does hereby guarantee that the student will fully perform and abide by the “Campus Housing Agreement Terms and Conditions” and hereby indemnifies and agrees to hold harmless Centenary College of Louisiana against any loss, claims, obligations, liabilities, costs, expenses, and reasonable attorney’s fees arising from the student’s failure to perform or abide by such agreement

Guardian's First/Given Name

Guardian's Family/Surname