SUNY Urban Teacher Education Center (SUTEC)  
Parkchester Housing Placement Request



Directions:  Please complete this application and attach it to your application for NYC student teaching. 




I.	Personal Data:

Last Name: ______________________________   First Name: ___________________________


SUNY College/University ____________________   Social Security #: _____________________


Expected Graduation:  Month  _____   Year _____


Campus Address: _________________________________________________________________


Campus Phone: ________________   E-Mail Address: ____________________________________


Permanent Address: _______________________________________________________________


Permanent Phone: _________________          Student Teaching Term:  Fall ___  Spring ___   Year____




II.	Do you have a specific roommate you would like to live with:  0 yes	0 No

  If you answered �yes� to the above question, please provide your roommate�s information below

  Last Name: _________________________________   First Name: _____________________________
  
  
  SUNY College/University _____________________