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Break Housing Form
Break Housing Form
All fields marked with asterisk (*) are required.
check_one
required checkbox field
Check one:
*
SPRING BREAK ($100.00 per week)
THANKSGIVING BREAK (No charge)
WINTER BREAK ($100.00 per week)
name
required text field
Name
*
id
required text field
ID
*
email_address
required e-mail address field
Email address
*
current_hall
required text field
Current Hall
*
room_number
required text field
Room Number
*
stay_in_room
required radio button field
Stay in room?
*
Yes
No
if_staying_in_a_different_room
required text field
If staying in a different room, please specify
*
dates_staying_on_campus
required text field
Dates Staying on Campus
*
reason_for_stay
required text field
Reason for stay
*
cell_phone
required text field
Cell Phone#
*
i_undersrtand_that_i_will_be_c
required checkbox field
I understand that I will be charged $100.00 per week (or any part of a week for this housing) except for Thanksgiving break.
*
Yes
Link (required)
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