Winter Break Housing Request Form

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All residential housing (including all halls, apartments, townhomes, and houses) is closed from 9am on Tuesday, December 20, 2022 until 12 pm/noon on Tuesday, January 3, 2023 (for those approved to be on campus over January term). Any students needing to remain on campus during any part of break (including departing late or returning early) MUST submit a break housing request form and be approved.

Deadline: Sunday, December 4, 2022
Note: Applications submitted after the deadline are subject to a $25 late processing fee.

First Name *

Last Name *

Student ID *

Enter carefully! This will be used to program your card access for the dates approved. (ex: 1234567, or 976543, etc).

Gustavus Email Address *

Include @gustavus.edu

Cell number

Current Residence Hall/Residential Housing: *

Room Number *

If your room has a wing/tower or A-D letter, please include it in your room number (015B, 101E, 204H, etc). If you live in an ILS house, please include the house name in this field.

Select All Dates You Need Housing *

Note: If you are waiting for a ride on Tuesday, December 20 please do not submit this form. You will need to vacate your residence hall by 9am as staff begin their room checks, but will be able to wait in the Jackson Campus Center.

I need housing for the entirety of the break: Tuesday, December 20, 2022 - Tuesday, January 3, 2023

Late Departure, Tuesday, December 20 (list departure time and reason below)

I only need housing for the following NIGHTS (please list below):

Early return on Monday, January 2, 2023 (halls open Tuesday, January 3)

Other:

If you only need housing for part(s) of break, please indicate all NIGHTS you will need housing (including departure/arrival date and times).

Select the Reason for Remaining on Campus *

International Student (please list country below)

Travel distance 350+ miles (please list city/state below)

Athletics Requirement (please list coach/supervisor name below)

Fine Arts (Music/Theatre & Dance) Requirement (please list supervisor below)

Student Employment (please list supervisor name and department name below)

Pre-Approved Accommodation (already approved by the Director of Residential Life).

Other (please give a full explanation below, for review by the Director of Residential Life)

Explanation for Remaining on Campus *

If you live over 350 miles away, list your home city and state or country. If you are required to be on campus for a department or org, please list that AND the supervisor's name. If another reason, list your specific reason for staying on campus for review by the Director of Residential Life.

Acknowledgement *

I acknowledge that all information above is accurate. Students are only approved to stay on the dates specified in their request, and only students with advanced approval can remain on campus (no guests are permitted; roommates are NOT PERMITTED unless they have submitted their own request and been approved; $150 per night charge per violation). All College policies remain in effect. Note that break housing information will be shared with the Dean of Students office, Campus Safety, and Facilities/Building Services.

I have reviewed and acknowledge all the above information.

Required

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