Colorado College Inn

COLORADO COLLEGE Residential Life and Housing 2014 Gap Housing Form

GAP STUDENT HOUSING REQUEST – May 21 – June 1, 2014

First and Last Name:

Student ID Number:

Current Residence: (Please note – students must move from their current residence, complete a check-out with Residential Life and Housing staff, and move to the CC Inn on May 21, 2014 between 12:00pm-4:00pm)

I will stay in my current residence until I move to the CC Inn on May 21st. YES NO I will move out of my current residence and return to the CC Inn on May 21st. YES NO CC Inn Check In Date: CC Inn Check Out Date:

I will be staying at the CC Inn only some of the days between May 21 – June 1. Number of nights: x (CC Inn - $33.00/night) = Total Due (You need to pick up your key at Loomis between 8:00 am – 5:00 pm Monday-Friday) OR I will be staying the entire length of Gap Housing May 21 – June 1.  The cost of Gap Housing is $300, payable by check or credit card through the Residential Life and Housing office in Bemis.  I will receive a credit of $50 to my student account if I live on campus for Block A.  I will receive an additional credit of $25 to my student account if I live on campus for Block B.  I am responsible for moving my belongings from my current room to my gap housing room on May 21, 2014.  I must follow proper checkout and check-in procedures for this move.

Payment Type: (Check One) Cash/Check Credit Card (Visa / MC)

Credit Card #: Expiration Date: Total amount due $

Permanent Address (Street)

(City) (State) (Zip Code)

Cell Phone Email

I do hereby agree to adhere to all the rules and regulations outlined in the Colorado College Pathfinder while I am on campus during the period above. I understand that once I have paid for my stay I will not be refunded. If I do not return the keys upon checkout that I will be charged for a lock change for each key that is not returned.

Signature Date