Modified Housing Renewal Form

Please be aware that this renewal is conditioned on the payment of your Room Deposit and submission of youHousing Application by the stated deadline (March 11, 2022). You must also meet with a staff member in the Officeof Residential Life to determine your housing placement and/or any roommates, if applicable, for the 2022-2023 academic year.

Please retain the copy of this confirmation email for your records once you submit this form.

Failure to follow the above procedures may result in being placed on a wait list for a room that meets yourapproved accommodation(s) and or/substitution, delay, or denial of your request based on facility availability.

Background Information
Your Full Name: Your Full Name: First Middle Last
Email Address
Detailed Student Information

Please be sure your contact information is accurate, including your active phone number.
ID Number
DOB (YYYY-MM-DD)
Phone Number
Hall / Off Campus Address
What is your current class status:
Disability for which accommodations have been approved:
Approved Accommodation(s) (please list accommodation(s) from your letter):
Text

Modified Housing Renewal Form

Modified Housing Renewal Form

Background Information

Detailed Student Information