Winter Break Housing Application 2020/2021 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 Stay Athletics Training Student Leader Other Other Please CHECK requested dates below: Tuesday, December 22, 2020 Wednesday, December 23, 2020 Thursday, December 24, 2020 Friday, December 25, 2020 Saturday, December 26, 2020 Sunday, December 27, 2020 Monday, December 28, 2020 Tuesday, December 29, 2020 Wednesday, December 30, 2020 Thursday, December 31, 2020 Friday, January 1, 2021 Saturday, January 2, 2021 Sunday, January 3, 2021 Monday, January 4, 2021 Tuesday, January 5, 2021 Wednesday, January 6, 2021 Thursday, January 7, 2021 Friday, January 8, 2021 Saturday, January 9, 2021 Please Note: You are only permitted to live on campus during the approved date (s). TERMS AND CONDITIONS Room Fees: NO CHARGE for Stay for the purposes of Athletic Training or Leadership duties. A cost of $15.00/day may be charged to your student account dependent on the reason for your stay. Campus Services will contact you by email when the application has been processed, enclosing confirming your check-in and/or check-out dates and fees for Stay. Official Move-out/Move-in dates Residence officially closes December 22, 2020 and re-opens Sunday, January 10, 2021. I understand all Ambrose University policies and procedures remain in effect during the break. I will abide by all the terms and policies listed in the Ambrose Community Life Standards Policy and Procedures and the Covenant of Residence Community Membership and Residence Policy. I am familiar with the details of these written agreements. I understand that any violation may result in removal from campus. The following conditions also apply: Overnight guests are not permitted in the residence during this time period. Remember to lock your room at all times. It is important to bring your student proxy card and room keys with you to access residence and your room. There may be facilities work occurring during the break period and you may be inconvenienced to a greater extent than during the academic year. Normal daily housekeeping services in residence will be limited during this time. Ambrose University Food and Dining Services may be closed. Therefore any money in your meal plan may not be in effect during some of this time period. If you require non emergency or facility assistance contact Ambrose University Security at 403-827-0108.