2016 Winter Break Housing Request Form
This form needs to be filled out by any student who is requesting to stay after the Residence Halls close on Friday, December 16, 2016 at 6:00pm (whichever comes first), or return before 8:30am on Saturday, January 14, 2017.

This form is for individual requests only.

**Neither on-campus nor off-campus employment commitments constitute as a legitimate reason to remain in on-campus housing over the break.

STUDENT TEACHERS: Fill out this form.

INTERNATIONAL STUDENTS: International students must inform the Center for International Education of their break plans. CIE will send a master list with your information to Residential Life.

STUDENT ATHLETES (who are in season and required to stay by their coach for the purpose of practice or competition): Please go through your coach to inform them of the accommodations needed. Your are not required to complete a break housing request form as your coach will the team's information to Residential Life.

This form is due no later than Friday, December 9 at 4:30pm.

All students who complete a Break Housing Form will be notified via email of either the approval or denial of their request.

Nazareth ID
This is a 7-digit number
Your answer
First Name
Your answer
Last Name
Your answer
Building
Room Number
Please ALSO indicate A, B, C, D if you live in the apartments and A, B in the upperclassman side for Clock Tower Commons
Your answer
Email Address
Please ensure that your email address is typed in correctly
Your answer
Reason for Staying
Note: Work of any sort does NOT constitute a legitimate reason for staying on campus, even if that work is for a faculty or staff member. Requests of this nature will not be approved.
Your answer
Name of Faculty/Staff Sponsoring You During Break (coach, teacher, etc.)
Your answer
Dates Requested
Please submit your date request using the following format: mm/dd - mm/dd. For example, 05/05-05/09 = May 5th-9th.
Your answer
Please check that you understand and agree to ALL of the following statments:
I understand during the break I may not have guests (anyone not approved to stay for break), regardless if they are Nazareth students. I understand I am expected to follow all College policies as outlined in the Undergraduate Student Handbook and Guidelines for Residential Living. If I violate a policy, including the guest policy for breaks, it will be documented I understand food service is not provided during the break. I understand I will receive an email either confirming or denying my request to remain on campus for a portion of the break; therefore, it is my responsibility to check my Nazareth email account. I understand during vacation periods, the Facilities Department may find it necessary to enter rooms to make repairs. I understand during vacation periods, the Department of Campus Safety conducts fire safety inspections in all buildings.
Signature
By entering your first and last name in the box below you acknowledge and accept the policies laid out in this document and will be considered a digital signature.
Your answer
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