Break Housing Request

  • Required fields are marked with an asterisk.* 

    First Name*

    Last Name*

    Capital ID*


    Residence Hall*

    Residence Hall Room Number*

    Which Break?*


    I plan to*:

    Stay until the following date:  [None] Select a Date Delete the Date  

    Please indicate below if you plan to stay for the entire break:


     Reason for Request*

    If other, please explain.


    If you are staying to work, employer verification must be turned in by due date of break application for you to be considered. No exceptions.

    I have read and accept the Break Housing Policies & Procedures. The information I have provided on my request is accurate. I have also had an opportunity to ask questions regarding Break Housing, including any questions regarding security risks, reduced staffing, services and facilities. I accept full responsibility and release Capital University from any loss, damage or injury that I may sustain while on campus during break.