Housing Request Form

Please complete all sections.
You should submit an application as soon as your rotation dates are confirmed.
You will be notified if housing is available during the requested dates.
Housing for out-of-state students, students from private or non-state supported academic institutions is provided at a rate of $75/week.

If you have any questions, please feel free to call Julie Ghent or Beth McDonald at (803) 286-4121 or email them at:

Julie Ghent - jughent@comporium.net
Beth McDonald - bmcdonald@comporium.net




Present Address
Permanent Address
_________________Rotation 1Rotation 2 (if applicable)Rotation 3 (if applicable)
Course Name and No.
Rotation Site/ Site Location/ Preceptor Name
Rotation Dates (Begin and End)
Housing Dates (Begin and End)