Please complete this form no later than 4 pm on Friday, April 26th, 2013. Housing will cost $175.00 per week for double occupancy apartment and $250.00 per week for a private apartment (only available if staying 3 weeks or more).
Last Name:
First Name:
Gender: Male Female
Student ID Number:
Phone Number:
Email Address:
Current Room Assignment:
Next Fall Room Assignment:
Home Address:
Current/Local Address:
Any Special Needs (i.e., accessibility)
Requested roommates names (if applicable)
Requesting Room Occupancy
Preferred Floor Level:
CHECK WEEKS YOU WILL NEED HOUSING:
Reason for staying on campus:
How did you hear about summer housing?
By submitting this form electronically, I agree to extend my 2012-2013 Housing and Dining Service Agreement with the Office of Residence Life for the Summer session. If you have not filled out a Housing and Dining Service Agreement, you may be asked to complete one before moving into summer housing. I am in acknowledgement of that my student account will be charged the total amount of my summer housing costs and that there is a $5 program fee if I intend to stay longer than two weeks this summer.