SINGLE ROOM REQUEST

Date Submitted: Month January February March April May June July August September October November December / Date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 2005 2006 2007 2008

Expected Graduation Date: Month January February March April May June July August September October November December / Year 2005 2006 2007 2008 2009 2010

Hall & Room Number:

Student's Name:    Box #:    Contact Phone #:

Single Rooms are first assigned to individuals who have a documented, severe medical need as determined by the college. If available, additional singles may be assigned according to seniority on a first come-first serve basis. Once this request is submitted the students name is placed on a Single Room Waiting List. There are only a limited number of single rooms available per semester, if any based on numbers.

By applying for a single room I understand and agree to the following:

• Single rooms are not guaranteed. The residence life office reserves the right to assign another student to an empty space at any time.
• If granted, a Single Room Fee will be billed to my account.
  (Information about fees and charges are available at the Residence Life Office.)
  
• If I apply for and receive a single room and I then wish to be in a double room, it will be my responsibility to inform the Residence Life Office and find a roommate. I will also continue to be billed for a single room until I supply the Office with the name of a roommate.
  

If I do not receive a single room, I would prefer to be my roommate. I understand that if I do not provide a roommate preference that the College will make the roommate assignment, if necessary, based on the information in the Resident Student Application attached. Single rooms are not guaranteed until the first day of the semester.

*Typing your full name constitutes your signature of this electronic document.

** This form will be processed directly to the assistant director of residence life.