Housing Hardship Request Form

Name

First Last

Email

Cell Phone

Residence Hall and Room Number

Date requesting to stay until (No one permitted to stay past Noon on Saturday, 12/5)

Do you wish to remain on campus over Thanksgiving? (Wed 11/25 – Sunday 11/29)

Reason you are requesting to remain in campus housing past closing...

Please explain thoroughly why you wish to remain on campus past Saturday, November 21:

Emergency Contact Name

First Last

Emergency Contact Relationship

Emergency Contact Phone

By typing my name below and checking the below boxes, If permitted to remain on campus, I acknowledge...

I understand that, if permitted to stay on campus, food service will not be available after lunch on Tuesday, November 24. The Panther Pantry will remain stocked through Friday 12/4 but only Flex dollars and cash/credit will be functioning.

I understand.

I understand that, if permitted to stay on campus, I will be expected to follow all College policies and the Panther Promise. I will be removed immediately if found to be in violation of a policy.

I understand.

I understand that, if permitted to stay on campus, I will not be allowed to have ANY guests in the residence halls.

I understand.

I understand that I might be asked to meet with a staff member in Student Services to give further information or documentation about this request.

I understand.