Break Housing Application & Agreement

Name(Required)

First Last

Phone Number(Required)

Email(Required)

Room Number(Required)

Please select why you are requested to reside on campus during the approved break period. Students must provide a specific rationale addressing the REQUIRED NEED to reside in on campus housing.(Required)

Reason for Request(Required)

Requested Days(Required)

11/22

11/23

11/24

11/25

11/26

11/27

11/28

11/29

11/30

Terms of Agreement

This agreement is to request to stay in the residence hall on the dates listed. A $25 fee per night will be billed to students. If the student has an outstanding balance on their account, the request will be denied. By submitting this form, I take full responsibility for the terms for the agreement. If I fail to uphold this agreement, occupancy will be terminated immediately. I understand that on-line classes do not qualify for break housing purposes. I understand that meal services is limited during the break.

Accept Agreement(Required)

Yes

I have access to the following forms of transportation. Please check all that apply for you:(Required)

Personal Vehicle

Uber/Taxi

Other

Other(Required)

Rules & Regulations

I understand that any damage done in the residence hall during this time can be charged to all residents staying in the hall at that time. I agree to abide by all Residence Life Handbook and Student Handbook policies. In addition, I agree to follow the additional Break Housing Rules which include NO OFF-CAMPUS GUESTS ARE APPROVED TO BE ON-CAMPUS DURING THE BREAK IN THE RESIDENCE HALLS. I understand the obligation to abide by these conditions and that violation of these rules will result in immediate termination of the Agreement, possible removal from the hall for the remainder of the break, and disciplinary action.

Rules Agreement(Required)

Yes

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