HMSC Housing Facilities
Request Form

Quarter Year
Department and Course:
(If for education program)
*Affiliation:


*Anticipated Number of Students:

*Total Number Requiring Housing:
(including chaperones and drivers)

Gender Breakdown: Male: Female:

 

Purpose of Visit:

 

Anticipated Housing Requirements:

Anticipated Linen Requirements:

 

*Arrival Date:

*Departure Date:

 

Room mate preference?

 

Other Requirements

Special Housing Needs or Other Comments

 

Contact Information

*Name (First & Last):
*Address:
*Phone:
*E-mail Address:

*Denotes a required field.