David Geffen School of Medicine at UCLA
Visiting Students Sublet Database Questionnaire
If you are interested in submitting a vacancy, please complete this form and submit electronically.
Create a Password:
NOTE: This will be used to later edit or delete your information in the database. Required
Your Contact Information
First Name:
Last Name:
Telephone:
NOTE: Please use this format (xxx-xxx-xxxx)
E-Mail Address:
Vacancy Information
Address:
Address (cont.):
City:
State:
Zip Code:
NOTE: Please use this format (xxxxx or xxxxx-xxxx)
Type of Vacancy:
Description of Vacancy:
NOTE:Please use this field to describe the vacancy, including amenities, and any preferences on tenant
Date vacancy will be available:
NOTE: Please use this format: mm/dd/yyyy
Amount of rent:
NOTE: Use only numbers, no dollar sign ($)
Is smoking allowed? Yes No
Are pets allowed? Yes No
By pressing the submit button below, I authorize the release of the above information to students of the David Geffen School of Medicine at UCLA.