Cable Television Move Form

* Requied field

1. Name * (first / last)
   
   
   
2. MHC Box
   
   
   
3. MHC Email
   
   
   
4. Class Year
   
   
5. Phone
   Campus Ext.
   Cell Phone
   
   
6. New Residence Hall *
   I am moving to: 3 Park Street 17 Morgan Street 24 Silver Street 57B College Street 1837 Abbey Brigham Buckland Dickinson Ham MacGregor Mead North Mandelle South Mandelle North New Hall South New Hall Pearsons Pearsons annex Porter Prospect North Rockefeller South Rockefeller Safford Torrey Wilder
   Room Number *
   
   
7. Old Residence Hall *
   I am moving from: 3 Park Street 17 Morgan Street 24 Silver Street 57B College Street 1837 Abbey Brigham Buckland Dickinson Ham MacGregor Mead North Mandelle South Mandelle North New Hall South New Hall Pearsons Pearsons annex Porter Prospect North Rockefeller South Rockefeller Safford Torrey Wilder
   Room Number *
   
   
8.  Yes, I am aware that a $10 cable move fee must be paid before activation.*