ACUHO-I Institutional Join Form

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Institution's Name

Required

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Institution's Type

Required

Public

Private

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Institution's Affiliation

Required

HBCU (Historically Black College or University)

Hispanic Serving

Religiously Affiliated

Tribal

Community College

Military Branch Affiliated

None of the Above

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Total Housing Capacity

Required

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Primary Contact

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*

Primary Contact Title

Required

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Primary Contact Email

Required

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Address Line 1

Required

Address Line 2

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City

Required

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State / Province / Region

Required

Zip / Postal Code

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Country

Required

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Phone Number

Required

Fax

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Select how many years to renew membership

Required

1 year

2 year with 5% discount

3 year with 10% discount

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