Short Stay Request

This form is for students and interns seeking short term housing. Short term housing is similar to a hotel in which you check in and check out in a period shorter than a week. Room charges must be paid before your stay begins. You will be given access to your room on a temporary card you will have to return upon check- out.

Please note the following information:

Our normal room is a double occupancy with shared bath at $33.00 per night. Other rooms are available at various prices. Please see the camps/conferences page for prices.

NOTE: Some room types may not be available. Please select a room type in the below form.

This bill is payable online. Instructions will be sent once completed.

Summer Break Housing Applications must be submitted 72 hours prior to moving into Summer Housing. Please remember Residence Life and Housing is only open M-F, 9am-5pm. Applications received on the weekend will not be viewed until the following business day.

If you need to cancel your request please email housing@csupueblo.edu at least 24 hours before your requested move-in date.

PERSONAL INFORMATION

First Name: *

Last Name: *

Phone number: *

What is your purpose at the university? *

Email: *

If you selected "other" as your response to the other question please explain below:

DATES OF STAY

Date of Arrival * +

Date of Departure * +

SPECIFIC HOUSING NEEDS

Do you have a medical condition, disability, or specific need that requires special housing accommodations? (you will be contacted via phone call to discuss specific accommodation requests) * *

What room type would you like? (Room type availability is limited and not guaranteed) *

Would you like linens provided at an additional $3.00 a night? Linens provided are (bedding, pillow, towels (2), hand towel (2), washcloths (4), light blanket) *

CRIMINAL HISTORY

Do you presently have any felony charges pending against you, or have you ever been convicted of a felony? *

Do you presently have charges pending against you, or have you ever been convicted of a misdemeanor of a felony sex offense crime, or an attempt to commit such a crime? *

MENINGOCOCCAL DISEASE- IMMUNITY

Colorado State Law requires the following information to be provided to each new student residing in student housing, or, if a new student is under the age of eighteen years, to the student's parent or guardian. The vaccination is voluntary; the decision to vaccinate is one the student, parent(s) or guardian(s) should make in consultation with their family health care provider. Meningococcal disease is a serious disease. Meningococcal disease is contagious, but a largely preventable, infection of the spinal cord fluid and the fluid that surrounds the brain. Scientific evidence suggests that college students living in dormitory facilities are at a modestly increased risk of contracting meningococcal disease. Immunization against meningococcal disease decreases the risk of contracting the disease. Vaccinations may be available through your family health care provider or your county health department. Please check with your health insurance to see if the vaccination is covered by your policy. I have reviewed the above information on Meningococcal Disease and: *

Have received the vaccine

Will receive the vaccine

Will not receive the vaccine

EMERGENCY CONTACT INFORMATION

This information will be given to medical personnel and the individual listed as the emergency contact may be notified in case of an emergency.

Name of individual to contact in case of an emergency: *

Relationship: *

Phone Number: *

Current Medications:

Allergies:

EMERGENCY CONTACT INFORMATION

By checking these boxes you agree to the following: *

I agree to abide by and follow of the items on this list.

I understand there is a charge to stay in University Housing.

I agree to follow the protocol for checkout and return the temporary ID issued to me

I have submitted accurate information and agree to all of the terms and conditions of living on campus over the summer. *

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