Residence Life and Housing Fall Stay Form

Please Note that ALL Residence Halls and Walking Stick Apartments will

CLOSE: Friday 11/20/20 at 5:00 pm

and

REOPEN: Sunday 11/29/20 at 8:00 am

THIS APPLICATION IS DUE BY 5:00pm Friday 11/20/2020

A $25 Late fee will be added for any application turned in past 11/20/2020 at 5:00pm.

For individuals that do not need to stay the entire Break select the date and time in which you will be leaving.

All communication regarding break housing will be through your CSU-Pueblo email.

Please email us before 11/20/20 if you wish to cancel your request at housing.csupueblo.edu.

First Name: *

Last Name: *

PIDXXXXXX *

(xxx) xxx-xxxx *

CSU-P Email Address *

Hall/Apartment *

Room Number: ex: 102B *

Are you staying the entire break? *

Yes

No

Move out date: (If you are staying after 11/20/20 select the date here) * +

Move in early: (If you are coming back before 11/29/20 select the date of your return) * +

Reason for Staying: *

Athlete (must have approval from athletics to stay)

International Student

Out of State Student

Required to Work (must have approval to stay)

Other: Other:

Athletes ONLY: Please list sport

Work Study (Department working for)

Please NOTE the following infomation:

• Requests to stay on campus during any break period must be approved by Residence Life & Housing.

• Residents must comply with Residence Life and Housing Policies and the Code of Conduct.

• Residents granted permission to stay over break are NOT allowed to have overnight guests.

• Dining Services will be CLOSED during the break period and will not be serving food.

• Residents are responsible for providing food for the break period.

Terms and Conditions: *

I agree to abide by and follow all of the items listed above in order to remain on campus over break.

I understand that if I do not need break housing, I must cancel my request in writing to Housing@csupueblo.edu no later than 11/20/2020 by 5:00pm, otherwise a $50.00 cancellation fee will be placed on my account.

I understand that if I apply for break housing after 11/20/2020 I will be charged a $50 late fee.

I understand that there will NOT be any Food Services provided during the break period.

Signature *