IW Winter Break Request Form

IW Winter Break Request Form
IW students can request to stay on campus during the winter break (December 9th - January 8th). Requests will be reviewed by university staff and only students with extreme circumstances will be eligible to stay after a review of your request. Cost for staying on campus is TBD. There will be no food service during the winter break so you will be responsible for your own meals.
Name*
First NameLast Name
IW ID#*
Email*
example@example.com
Phone Number*
Area CodePhone Number
Residence Hall*
Room*
Home Address*
Street Address
Street Address Line 2
CityState
Zip Code
I am requesting to stay on campus for (meals service will not be provided during this time)?*
Entire holiday break (December 9 - January 8)
I am requesting to stay on campus during the winter break for the following reason:*
Housing Insecurity (no place to go)International StudentAthleticsOther
Other: In the space below, please state the reason for your request. Please describe your request in as much detail as possible, considering the grounds stated above.*
Which Team*
Men's BasketballWomen's BasketballMen's WrestlingWomen's Wrestling
HARDSHIP WAIVERS
A hardship waiver is for any students that may have the need to stay on campus for no charge over the winter break. If you are interested you will be sent the application. Once the application is complete a committee will determine if your application to stay for free is approved or not.
Are you interested in applying for a hardship waiver to stay over winter break?*
YesNo
You will receive an email soon with the hardship waiver application from the Student Development Office. Please continue to monitor your email.
By requesting winter break housing and by signing this form I understand that if approved I will be charged for housing starting on December 9th through January 8th. Charges for winter break housing will be posted to your student account if your request is approved. I also understand that if I am approved to stay I will be expected to follow all university policies including but not limited to visitation/guests, quiet hours, alcohol, and drug policies. At certain times during the break the university will have limited staff on campus (Residence Life, Security, Maintenance, etc.) so please be aware that certain issues may have a untypical response time.
Signature*
Clear
Should be Empty: