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2018 MAQ Emergency Contact, Special Needs and Room/Suite Mate Request
This form should be filled out AFTER registering and paying for classes and housing.
Your Name *
Your answer
Your email address *
Your answer
Phone number *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone Number *
Your answer
Roommate (if in double)
Your answer
Suitemate Request 1
Your answer
Suitemate Request 2
Your answer
Suitemate Request 3
Your answer
Special Needs - It helps us to accommodate your special needs, if you provide us with information before the weekend.
If you are staying in a dorm without an elevator, do you require a room on the first floor? This is not guaranteed unless you chose Powell Hall.
Please describe any special needs you have, including any accommodations you need.
Your answer
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