Extension Request Form :                                          Due Wednesday, May 8th at 5PM
I am currently requesting an extension to remain on campus because of the reasons listed below.  I understand that I still must register for a check out time and be checked out by the time stated below.  I understand that my Hall access will not work after the stated time and that I am to not have any visitors in the hall (except those immediately helping me move out).  This action is a right granted outside the scope of my room contract.  I understand that I am expected to abide by all College regulations – and failure to do so will be cause for removal from the Halls or fines to my account.
First Name *
Last Name *
Email *
ID Number *
Phone number *
Hall *
Room Number (Ex. 101A) *
Why are you requesting an extension to check out at a later date?   *
If requesting an extension for reasons other than those listed above please provide your request below. Any approved extensions for reasons other than those listed above are subject to a possible $30 a day charge. *
Any approved extensions other than the ones listed above will be subject to a $30/day charge. By initialing below, you are agreeing to pay the charge. *
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