Department of Campus Life

Spring Break Request to Stay Form

Due to campus safety and security issues, we need to know which students will be on campus, and when students will be here. Please submit this request to the Campus Life Office no later than 5:00 p.m. on Friday, March 9th.

First Name:
Last Name:
LU ID:
Cell Phone:

Hall/house (Winter term): Room:
Hall/house (Spring term): Room:

Requested Date(s) To Remain On Campus:
If you request to stay on campus the entire break, please use dates March 16, 2012 to March 24, 2012.

From: Month: Day: Year:

To: Month: Day: Year:

NOTE: Please understand that if you are changing room assignments, you will need to make arrangements and move into your spring term assignment no later than Thursday, March 15th at noon.

(enter the above code into the box below)