Please complete the entire form. If you have difficulty sending the form, please check to make sure you have answered all required questions in the form.

Contact Information
Contact Information
First Name: A value is required. Last Name: A value is required.
Address: A value is required.
City: A value is required. State/Province: A value is required.
Zip/Postal Code: A value is required. Country: A value is required.
Email: A value is required.
Telephone: A value is required. Cell Phone: A value is required.
Emergency Contact: A value is required. Emergency Contact's Phone: A value is required.
Personal Information
Personal Information
Government-Issued Photo Identification:
(country, type of identification and number)		 A value is required.
Date of Birth: Please select an item. / Please select an item. / A value is required.
Gender: Male: Female:
Occupation A value is required. School Attending: (if applicable)
Employer or Internship (if applicable):
Your reason for selecting Golden Hill Place: A value is required.
While sleeping, I prefer: Complete Silence Queit Sounds Moderate Noise Loud Noise
My cleanliness level is: Very Clean Clean Average Messy
Additional needs or preferences:
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Rental Rate & Roommate Preferences
Rental Rate & Roommate Preferences
Click Here For Floor Plans
Apartment 1 | Double Occupancy (Share) Apartment 3 | Double Occupancy (Share)
Apartment 1 | Single Occupancy (Private) Apartment 3 | Single Occupancy (Private)
Apartment 2 | Double Occupancy (Share) Apartment 4 | Double Occupancy (Share)
Apartment 2 | Single Occupancy (Private) Apartment 4 | Single Occupancy (Private)
 
If you prefer a private apartment, are you willing to stay temporarily in a shared apartment with a resident of the same gender until a private apartment becomes available?
Yes No
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Rental Period
Rental Period
Preferred move-in date: Please select an item. / Please select an item. / A value is required.
Latest possible move-in date? Please select an item. / Please select an item. / A value is required.
Move-out date, if known: Please select an item. / Please select an item. / A value is required.
Rental Period: Month to Month 1 - 3 Months 3 - 6 Months 6 - 12 Months Over 1 Year
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Rent Payment Information
Rent Payment Information
Source of Income A value is required.
Method of Rent Payment: Personal Check Cash Traveler's Check Credit / Debit Card (Visa, Master Card, Discover)
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Visitors & Guests
Visitors & Guests
Golden Hill Place limits the number of guests you may have staying with you to one guest at a time; each guest with a maximum stay of 1 week; not more than 2 guests within a 2-month period. There is a $25.00 Guest Fee that will be charged to you for utility costs. An air-bed and linens will be provided upon request for a Set-up & Laundry Fee of $25.00.
 
Do you have plans for visitors (friends or family) to sleep in your apartment during your stay at Golden Hill Place? Yes No
If you answered "Yes" to the Visitor question above:
Durring which month, if known?
What is the length of his/her stay?
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Referral Information
Referral Information
How Did You Learn About Golden Hill Place?
School Hostel International - San Diego
Internship Craigslist.com
Friend Internet search engine (i.e. Google, Yahoo, Ask.com, etc.)
ESLUSA.org Other
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Confirmation Policy
Confirmation Policy
Please make a selection. By Checking this box, you agree to the Confirmation Policy
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NOTE: All required fields must have values in order for this form to be submitted.
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