Proxy Form

Housing Selection 2017

Students unable to participate in the Housing Selection Process on the day and time that they are scheduled may designate a proxy, a person authorized to act for another on their behalf. Completing this form will allow another student to act on your behalf and make decisions regarding your housing for Fall 2017 – Spring 2018.

 In order to participate in the Housing Selection Process a student must have paid the $400 housing deposit to the Student Accounts Office and be registered for 12 or more credits for the Fall 2017 semester.

 Please give this form to your proxy. The proxy must bring this form to Housing Selection and will be admitted at the assigned time for the student for whom they are proxying.

 If the requestor would like a member of the Office of Residence Life to act as their proxy, please return this form to the Office of Residence Life (Linden Hall, Worcester) by Friday, April, 7, 2017.

 After signing up for housing you will have 24 hours to complete your 2017-2018 contract in the Residence Life Office (Linden Hall, Worcester), or you will lose your room.

To be completed by the absent student:

Student Name: ______Student ID Number: ______

Cell phone number: (_____) ______-______Lottery Number: ______Meal Plan Option: □ 19 Meals per week □ 10 Meals per week (Willow or Spruce only)

□ 14 Meals per week □ 5 Meals per week (Willow or Spruce only)

Residence Hall Preferences:

1.) ______3.) ______

2.) ______4.) ______PROXY FORM AUTHORIZATION

I hereby authorize ______(print name of proxy or write in “Residence Life”) to serve as my Proxy during the 2016 Housing Selection Process. I fully understand that I am responsible for instructing my proxy with regards to my room preferences and obligated to accept the assignment that they choose on my behalf.

Your Signature: ______Date: ______