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BREAK OCCUPANCY FORM
      I declare and understand that by providing valid Ithaca College Student ID numbers with this form, that ...
  • all residents and occupant(s) of the room, suite or apartment have thoroughly read and agree to comply with the Recess Housing requirements disclosed on this web site and the Break Closing Notice appropriate to the occupancy period being requested, and have granted permission to all non-resident student occupant(s) listed to reside within the room, suite or apartment indicated.
  • each Break occupant indicated on this form, including the current resident, is designated exclusive use of the current resident's bed for the occupancy period requested, and that the capacity of each room, bedroom, suite, or apartment will not be exceeded.
  • this form is not grant of approval for any requested occupancy.

Building: Room or Apt (include bedroom letter as applicable) IC E-mail: 
Name          
Student ID #
(check all dates that the occupant will be in room)

Current Resident:

(required even if the resident will not be
staying for any portion of the break)
03/08
03/09 03/10 03/11 03/12 03/13 03/14 03/15

Non-Resident Occupant:

(student other than the resident who will
be staying for any portion of the break)
03/08
03/09 03/10 03/11 03/12 03/13 03/14 03/15

Additional Occupant:

(student other than the resident who will
be staying for any portion of the break)
03/08
03/09 03/10 03/11 03/12 03/13 03/14 03/15

      By submitting this form, I acknowledge that I have thoroughly read and understood the information disclosed above. 

Updated: Wednesday, February 20, 2008 | Residential Life Web Administrator, Linda Koenig (lkoenig@ithaca.edu)