Questionnaire

2002 Fulbright Summer Institute
University of California, Santa Barbara
(please print)

Name _____________________________________ Country ___________________

1. What name would you like us to call you? ______________________________________

2. When are you scheduled to arrive in Santa Barbara? Day:____________ Time ____________ Airline _________________ Flight #__________

NOTE: If you discover that you will not be arriving at the time indicated, please notify us immediately. (Phone numbers will be provided in the information packet.)

3. Person to contact in case of an emergency:

Name
_________________________________________

Complete Address
_________________________________________ _________________________________________ _________________________________________

Phone number (day) _________________________________________

Phone number (night) _________________________________________

4. Please indicate how you can be contacted by FAX or Internet (if available):

FAX number: _____________________________

e-mail address: ____________________________

5. Do you have a United States Taxpayer Identification Number (TIN)?

No __ Yes __

if yes, what is it? __________________

6. Personal Habits (in order to choose suitemates and serve your personal needs)

Smoker __ Non-Smoker __ No eggs/dairy __ No beef __ No pork __

Halal __ Kosher __ Vegetarian __

Other dietary needs: _____________________________________________________

Food Allergies: ________________________________________________________

7. We would like to provide you with as many amenities as possible in your suites, please rank the following items according to your desire to have them in the suite

___ Coffemaker
___ Toaster
___ Iron
___ Extra Blanket (one per bed provided)
___ Extra Study Lamp (one per room provided)
___ Radio/Alarm Clock
___ Lg. Fry-pan (sautee)
___ Sm. Fry-pan
___ 1-Qt covered saucepan
___ 2-Qt covered saucepan
___ Baking pan
___ Large Knife
___ Bottle opener/corkscrew
___ Dishtowels
___ Mixing Bowl set
___ Measuring cups/measuring spoons
___ Wine Glasses
___ Salt and Pepper shaker set
___ 4-Qt. Colander
___ Vegetable Peeler