Institution:
Department:
Institution Contact Name:
Phone:
Email:
Approx. number of Rooms of Furniture:
New Hire Name:
Spouse/Partner's Name:
New Position:
Current Home Phone:
Cell Phone:
Current Email:
Current Residence Address:

Street:
City:
State:
Zip:
Comment:

Destination Address:

Street:
City:
State:
Zip:
Comment:

Approximated Relocation Date:
Standard School/department policy applies: Yes No
Or total dollar limit budget to new hire:

Unless we have your institutions standard policy on file, please complete the balance of this form noting services authorized and or requested.

All HERS program service benefits, resources and discounts will apply regardless of whether the institution is paying all, some or no portion of the relocation expenses.

If an allowance has been stated, affiliate will be counciled on budgeting and any balance beyond the allowance will be at their expense (payable on service delivery via cash, certified check or credit card).

Home Marketing/Purchase Assistance: No fee referral service Yes No

Area Familiarization Tour: Please click here for more information about this valuable recruiting tool. Half day custom tailored tour
Full day tour

Temporary Housing up to days or $

Spouse/Partner Employment Resources
Yes - Fee based counseling authorized
No - fee online resources

Rental Assistance (fee based)
Yes No

Mover Packing/Unpacking below refers to the additional fee of boxing up loose items, not loading and unloading the truck, which is standard with professional moving services.

Packing Material for self packing
Yes No

Full Mover Packing Service
Yes No

Mover Packing of fragile only
Yes No

Full Mover Unpacking Service
Yes No

Mover Unpacking of Mattresses only
Yes No

Packing material debris pick-up (included in unpacking service)
Yes No

Wood Crating/Uncrating Service
Yes No

Extra Stops at other than Primary residence
Yes No
(# authorized)

Appliance/Fixture Servicing/disconnect reconnect
Yes No

Auto Transportation
Yes No
Vehicle Make, Model and Year

Bulky items:
Pianos: Yes No
Riding Mowers: Yes No
Big Screen TVs: Yes No
Boats/Canoes: Yes No

Storage up to 30 days
Yes No
Storage beyond 30 days
Yes No up to days

Pet Transportation:
Yes No

Settling In Services (assistance with completion of local registration or legal documentation paperwork; residence preparedness extras i.e. maid service, window treatment installation, etc.)
Yes No

Laboratory Relocation Project Management - please complete a Lab Relocation Project Management Service Request Form Yes No