Spring 2021 Extension of Stay Housing Application First Name Last Name Student ID Cell Phone Number Personal Email Address Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Gender Male Female Residence Wilson Residence Res-Ed Room Number Emergency Contact Info First Name Last Name Relationship to you Emergency Contact Phone Number Reason for Extension of Stay Graduation Internship Seminar Other Please CHECK requested dates below: Tuesday April 27 Wednesday April 28 Thursday April 29 Friday April 30 (grad - Education) Saturday May 1 Sunday May 2 Monday May 3 Tuesday May 4 Wednesday May 5 Thursday May 6 Friday May 7 Saturday May 8 (grad - A&S, SoM, Seminary) Sunday May 9 Please Note: You are only permitted to live on campus during the approved date (s). TERMS AND CONDITIONS Room Fees: NO CHARGE for Extension of Stay for the purposes of Graduation or Internship Seminar. A cost of $35.00/day or $175.00/week may be charged to your student account dependent on the reason for your extended stay. Campus Services will contact you by email when the application has been processed, enclosing an Individual Residence Booking invoice confirming your check-in and/or check-out dates and fees for Stay. Move-in/Move-out Every attempt will be made to allow you to remain in your current room. Should it be necessary for Campus Services to relocate you, instructions will be given regarding the move. You will complete the 'check-out' procedure for your current room and receive information on your relocation.