Name:

Date:

Student ID Number:

Campus Phone:

Email Address:

Campus Address:

Gender:
Female
Male

Department for which you will work:

Supervisor's Name:

Supervisor's Office Phone:

Number of hours you will work each week:

Dates of Employment:

Are you being housed on campus in the Fall?:

Begin date of housing/meal request:

End date of housing/meal request:

Room-type preference:
Single (this is not guaranteed)
Double

Please list roommate preference (this is not guaranteed):

Please choose one room/board package:
$76 per week - Double room with 10 meals $94 per week - Double room with 15 meals $111 per week - Double room with 20 meals $102 per week - Single room with 10 meals $120 per week - Single room with 15 meals $136 per week - Single room with 20 meals

Conditions for Summer Housing:

1) I understand that summer housing is available from 4:00 pm on Sunday, May 17, 2009 until 12:00 pm on Wednesday, August 12, 2009 as long as I am employed full-time (at least 37.5 hours per week) by Ithaca College.

2) I agree to pay the amount indicated per week, based on my summer room and board choice on my application. This will be billed to my account in the Bursar's Office at the end of the summer. I will pay a non-refundable deposit of $50 when I submit my application. (This deposit will be deducted from my bill before it is billed to my account.)

3) I agree to abide by all Ithaca College rules, regulations, and policies as outlined in the Residential Life Guide, Student Handbook, and any other notices published by the Office of Residential Life and/or the Summer Housing Office. If I violate any College regulations or policies, I know that action will be taken which may include termination of my summer housing.

4) I agree to follow all check-in and check-out procedures and know that I will be billed for any damages to my room beyond normal wear and tear.

5) I understand that Ithaca College will not provide storage for my personal belongings for any time period before May 17, 2009 or after August 12, 2009 and that I must remove my belongings from my room when I check out.

Please type your first and last name and today's date to agree to the above statement:

First and Last Name:

Date (Month/Date/Year):