Summer Housing Request

Required fields are marked with an asterisk.*

Layout table for form.
First Name*	Last Name*
Capital ID Number*	Contact Phone Number*
Email*	Current Residence Hall Building and Room
Gender Male Female	Smoker Yes No
Roommate Request 1
Roommate Request 2
Roommate Request 3
Living on Campus 2013-2014? Yes No	Will you remain in your current housing assignment until your Summer Housing assignment is available? (Please note, residents will be charged for this time period) Yes No
Desired move-in date [None]	Desired move-out date [None]
Reason for Application:
Other Information you want us to know