1. Name
First *
Last *

2. Class year *

3. Phone Number *
Type * Cell Extension

4. Current housing assignment * choose one 3 Park Street 24 Silver Street 17 Morgan Street 57B College Street AbbeyBrighamBucklandDickinson1837HamMacGregorMeadNorth MandelleNorth New North RockefellerPearsonsPearsons annexPorterProspectSaffordSouth MandelleSouth New South RockefellerTorreyWilder
Room number *

5. Email (ex: lyon22m@mtholyoke.edu) *

6. ID Number (400 or 500) *

7. During November 25 - 29, 2009, I will be on campus for the nights of:

8. Please use this space for additional information that may assist us in meeting your housing needs.

9. Student Agreement

• I understand that there will be no regular meal service in the Residence Halls or Blanchard Campus center and it is my responsiblity to organize my own meals.
• I understand that many of the college services, including Residential Life, Health Services, and Counseling Services will not be available during the break and in the case of an emergency, I will contact Public Safety at ext. 2304 or 413-538-2304.   
• I understand that I am responsible for the security of the hall.
• I agree to keep all outer doors locked and to abide by all residential policies during the break including but not limited to the Guest and Escort Policy.
• I will be considerate of others who need to use the kitchen. 
• I will be responsible for cleaning the kitchen after using it.  
• I understand that in the event of a bill for a cleaning fee, I will still be charged regardless of the amount of time spent in the kitchen and whether or not I used the kitchen.
• I agree to remove all personal leftover food items from the golden pair refrigerator when the break is complete.

I understand and I agree *