Residence Life

University of Wisconsin-Superior

Yellowjacket Union 140
Belknap and Catlin
P.O. Box 2000
Superior, WI 54880

ph. 715-394-8438

fax. 715-394-8454

hours:
7:45am-4:30pm

Search the Residence Life Website:

Short-Term Summer Housing Contract Form

First Name:
Last Name:
Your Email Address:
Preferred Phone Number:
Address:
City:
State:
Zip Code:
UWS Student ID (UWS Students Only):
Age (as of May 20, 2013):
Gender:
Academic Status:
Academic Status (Other):

Type of Housing Preferred:
Short Term Student (1 night - 4 weeks):
If you selected DOUBLE ROOM, enter your roommate's name:
Requested Floor:
Living in Crownhart During Acadmic Year:
	If you will be living in Crownhart Hall during the 2013-14 Academic Year, enter the room number you've selected.

Dates of Housing: If you selected to live in Crownhart Hall for certain periods of time, please enter the dates:
Date 1 Check In:	mm/dd/yy
Date 1 Check Out:	mm/dd/yy

Date 2 Check In:	mm/dd/yy
Date 2 Check Out:	mm/dd/yy

Date 3 Check In:	mm/dd/yy
Date 3 Check Out:	mm/dd/yy

Date 4 Check In:	mm/dd/yy
Date 4 Check Out:	mm/dd/yy

Comments about these dates:

Other Information:
Emergency Contact Name:
Emergency Contact Phone Number:
Please list any disabilities or concerns we should be aware of when making your housing assignment:

I agree to the terms:
	By entering your initials, you are agreeing that you have read, understood and agree to the University and Residence Life Policies stated above and online and any related charged to damages.

University of Wisconsin-Superior: College degrees, bachelors, masters