Housing & Dining Renewal

Housing & Dining Renewal
Housing & Dining Renewal
First Name:
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Middle Name (or initial):
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Last Name:
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Preferred Name:
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Name of Parent or Guardian:
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Primary E-mail:
Street Address:
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City:
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State:
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Zip:
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Country:
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Home Phone Number:
Cell Phone Number:
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Major or Course of Study:
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Date of Birth:
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Gender:

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Student: Please complete accurately and honestly
In order to best meet your housing needs, please complete the following information. We will attempt to honor all preferences upon space availability.
I have a disability or medical condition that may affect my housing assignment.

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If you answered yes to the above question, please email jtucker@harcum.edu a statement of explanation as well as necessary medical documentation from a physician. This information will remain confidential and will be used to assist us with your housing needs. Please note, all housing accommodations are granted on a need basis and approved by the Coordinator of Disability Services and the Director of Residence Life.
I will be attending the following semesters and will require housing. Please check all that apply.




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**All Summer Session residents will be housed with a roommate on the 2nd floor of Pennswood Hall.**
Fall/Spring 2016-17 Residence Hall Preference:



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$100 room reservation fee is due before receiving a room assignment.

Please note: Single rooms will be an additional $750 per semester; this fee will go on your bill once you decide to get a single room. Single room availability is limited, and is granted on a first-come, first-serve basis. The College reserves the right to rescind single rooms at its discretion.

Roommate Preference:
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This is a preference - NOT A GUARANTEE. Note: Written mutual consent from both/all roommates is necessary to ensure placement. Please consult with the person you list before submitting this application. All applicants must have all names listed.


Suite Mate Preference:
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Listed above are the names of the residents that my roommate and I would like to share a suite. Note: Written mutual consent from all suitemates is necessary to ensure placement. Please consult with the persons you list before submitting this application. All applicants must have all names listed.
All resident students are automatically enrolled in the Harcum College residential meal plan which includes 19 meals per week. The undersigned agrees to abide by the Harcum College Conditions of Occupancy and the Student Code of Conduct as outlined in the Student Handbook.
Student Signature:
required
Date:
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