Housing Form

Housing form for Free Press scholarship recipients attending the 2008 National Conference for Media Reform June 6-8, 2008.

The housing location is Middlebrook Dormitory, University of Minnesota (Twin Cities campus)

Free Press has arranged for modest accommodations on the campus of the University of Minnesota for scholarship recipients and other conference attendees seeking low-cost lodging. We are offering this shared lodging option to scholarship recipients in order to stretch resources to help as many people as possible attend the conference. If lodging in shared accommodations or at the Middlebrook Dormitory is problematic for you, please let us know. Any special requests must be made by Wednesday, May 7.

Dorm room accommodations with daily breakfast will be offered to each scholarship recipient on a space available basis. Please provide the following information so that we may assign you space in the dorms and match you with a roommate for the duration of your stay in Minneapolis.

Personal Information

First Name: *

Last Name: *

Address: *

Please enter your permanent mailing address.

City: *

State: *

ZIP: *

Telephone:

Cell phone:

Email: *

Scholarship Confirmation Number:

Enter the number provided in the confirmation you received after applying, if you have it.

Date of Birth:

Gender: *

Nights you need lodging: *

Thursday, June 5

Friday, June 6

Saturday, June 7

Check all that apply

Special Circumstances

Do you have any health issues we should consider?: *

Yes

No

If yes, please briefly describe:

Please note: We are unable to provide refrigeration for medical supplies.

Do you have any accessibility needs we should consider?: *

Yes

No

If yes, please provide a brief description:

Other Details

Do you smoke?:

Yes

No

Please note: All rooms are strictly non-smoking

Sleep Habits:

I'm a night person — I stay up late (past midnight)

I'm a morning person — I get up early (before 7 a.m.)

Specific media reform interests:

What's brings you to the conference?

Roommate Request:

Please give the name(s) of other scholarship recipient(s) you know and would like to room with, if any.

Housing Description

Information on Middlebrook Dorm can be found here

Hall Amenities

Kitchenette and microwave on every floor of main wing
Social lounge on every floor
Sports and recreational equipment, games and VCRs/VCPs available for check-out
Ice machine
Laundry facilities
Music practice room and piano
Computer Labs & Cyber Cafe (Request use in advance)
Conference rooms
Card access at main entrance

Room Amenities

Telephone jack (telephone available with advance notice)
Single-size bed (extra long single)
Mattress pad
Linens and pillow
Closet
Drawer space
Desk and chair
Smoke detector
Window coverings
Carpeting
Air-conditioning
Semi-private baths - to be shared with roommate
Towel Exchange available everyday at front desk

Additional Information

Check in will be available 24 hours a day, starting Thursday at 12pm (noon) until Sunday morning. Check out must be no later than 3pm Sunday.
Breakfast will be available at Middlebrook dining hall Friday, Saturday and Sunday mornings and is free of charge for Free Press scholarship recipients. A schedule of breakfast-hours will be provided at check in.
Shuttle transportation from the dorm to the convention center will be provided free of charge at the start and conclusion of all conference days. A complete shuttle schedule will be provided at check in.

Terms & Confirmation

Agreement: *

I UNDERSTAND THE TERMS LISTED ABOVE AND AGREE TO ABIDE BY ALL RULES AND REGULATIONS OF FREE PRESS AND THE MIDDLEBROOK DORMITORY

The application MUST be received by 05/7/08. Late applications will not be considered. Electronic submissions are highly preferred.
Roommates will be assigned by Free Press based on applications alone. Due to the volume and complexity of housing applicants we can not guarantee personal pairing requests.
Submission of this housing application form does not guarantee housing provided by Free Press at the Middlebrook Dormitory at the University of Minneapolis Twin Cities campus, nor does it guarantee specific roommate assignments. Free Press reserves the right to accept or reject any housing applicationfor any reason.
Drinking, smoking, illegal drug use or breach of any Middlebrook Dormitory regulations is strictly prohibited and grounds for Free Press to revocate your housing offer and require to vacate the dorms immediately.
Dorm check in is NO EARLIER than noon on Thursday June 5, 2008. Dorm check out is NO LATER than by 3pm on Sunday, June 8, 2008.
NCMR Scholarship recipients staying in Middlebrook Dormitory are not allowed to have overnight guests. No one else may sleep in your room but you and your asssigned roommate.

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