Student Development Letterhead

Vacation Housing Application

If applicable, you must submit your vacation housing clearance/payment receipt along with this application to SCC 231 by the specified date to confirm your reservation request. Clearances and payments are handled by the Bursar's Office.
VACATION PERIOD REQUESTED:
NAME: LAST 4 DIGITS OF SS#:
CURRENT CAMPUS ADDRESS:
Residence Hall: Room #: Box #: Phone ext:
CELL PHONE: EMAIL:
ROOMMATE PREFERENCE (if any):
DATES NEEDED:
REASON FOR STAYING (please note that all reasons are subject to approval and confirmation by the Office of Student Development)






IF APPLICABLE, METHOD OF PAYMENT