Staying for Breaks Form
Name
*
First Name
Last Name
W Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Must be your WNMU Email
Building
*
Please Select
Centennial Hall
Mustang Village AN
Mustang Village AS
Mustang Village B
Mustang Village C
Muir Heights
Room Number
*
Which break will you be staying for?
*
Fall Break 2025
Winter Break 2025
Spring Break 2026
I understand that campus is closed during this break.
*
Initial Here
I under that during this time, there are no on-campus dining facilities open and Housing staff are not responsible for providing meals options for me.
*
Initial Here
I understand that despite there being no dining facilities open, the Housing policies regarding cooking appliances still apply to me.
*
Initial Here
I understand that there will still be Housing staff on campus during these breaks and they are permitted to conduct room checks.
*
Initial Here
Signature
*
Submit
Should be Empty: