The student's electronic signature and submission of this form indicates that he/she has read and agrees to the above statements regarding break housing.
Please complete the following information. Required fields are marked with an asterisk (*).
Please enter your phone number in the following format: xxx-xxx-xxxx.
If you are required to remain in the halls by a University department, your request must be verified by your supervisor or coach.
Please check your information carefully for accuracy, and then click "Submit."