Resident Life Summer Housing Form

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Resident Life
Summer Housing Form
2800 Palmyra Road
Hannibal, MO 63401
800-HLG-1119 fax: 573-221-6594
RESIDENT LIFE FORM INSTRUCTIONS
(1) Complete this form and submit to the Student Development Office by (date) ______________. Students are only assigned a room after this form has
been submitted. All students in resident housing must abide by the policies in the student handbook.
(2) All housing requests are subject to space available and date received.
Tell Us About Yourself
Name:_______________________________________________________ Preferred Name: ___________________________
Home Phone (____) ________________________ Cell Phone (____) _________________________ Campus ext.:________
Email Address ______________________________________________________________________ Campus box # ________
ID # ________________________________________ Expected Classification:
q Sophomore
q Junior
q Senior
Total credit hours earned: _______________
Attempted hours this semester: ______________ Birthdate: ____/____/____
Summer Housing:
q I am requesting summer housing for:
q May
q June
q July
q All Summer (May-August)
Roommate Preference (optional) Roommate requests must be mutual and in writing.
1st Choice:
______________________________________________________________________________
Last
First
Hometown
2nd Choice:
______________________________________________________________________________
Last
First
Hometown
3rd Choice:
______________________________________________________________________________
Last
First
Hometown
Notes:
1. Disciplinary problems may limit re-admission for any term.
2. Full-time academic status is required for residents.
3. Roommate preferences are not always possible, but RL Staff makes every effort to match up requests.
4. Private rooms are only available based on space and at an additional fee.
5. Approval of apartment living is based on following conditions:
a. Discipline
b. Final approval by Associate Dean of Residential Life
Applicant Signature ___________________________________________________________________ Date ____/____/____
FOR OFFICE USE ONLY
Date submitted:____________________________
HOUSING ASSIGNMENT:
Hall: ______________________________ Room #: _________
Revised 11/10

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