Last Name:

First Name:

Student ID Number:

Phone:

Anticipated Graduation Date:

Emergency Contact:

Emergency Phone Number:

Department working for:

Department Contact:

Student to pay for housing? Yes or No.

Department to pay for housing? Yes or No.

Work Start Date:

Work End Date:

Are you fully vacating the Colleges premises 24 hours after your last exam? Yes or No.

If no, have you contacted Res Ed. for an extended stay? Yes or No.

Existing School Year Residence:

Existing School Year Room Number:

Fall Residence:

Fall Room Number:

3 Roomates/Housemates Names (Not 100% guaranteed, but we will work to accomodate):

Please select "Yes" to indicate you have read and understood that the submission of this form DOES NOT approve nor guarantee summer on-campus housing.   The Director of Conferences and Events will meet with the Department contact listed on submission form, Student Affairs Office and the Deans’ Offices for final approval.  Once the student is fully approved, the Director of Conferences and Events will be in contact with the student via e-mail.