| First Name: |
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| Last Name: |
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Hamline Student ID#:
(not required) |
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| Gender: |
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| Primary phone number: |
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| Alternate phone number: |
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| Mailing address: |
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| City, State, Zip Code |
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| Email address: |
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| Program/class attending: |
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Special housing needs:
(if applicable) |
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| Emergency contact name: |
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| Emergency contact phone number: |
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| Date of arrival: |
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Approximate time of arrival:
(Please note a.m. or p.m.) |
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| Date of departure: |
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Approximate time of departure:
(Please note a.m. or p.m.) |
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Number of overnights:
(Minimum 3 nights) |
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| Select housing option: |
Residence hall single room $15.00/per night/per person
Residence hall double room $12.00/per night/per person
Linen packet $8.00 (sheets, pillow case, towel, and washcloth) |
Roommate request:
(not required) |
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Agreement
By submitting this form, I agree to abide by all Hamline University student conduct policies. I understand that my student account will be billed for the number of nights I have indicated on this form.
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