Summer Housing Application

First Name:

Last Name:

Student Id#/P#:

Current Room Number:

Cell Phone Number:

E-mail Address:

Roommate Request:

Birth date:

Gender:

Male

Female

Which session(s) do you need housing for:

Session I (May 25 - July 1) 38 Days

Session I A (May 25 - June 13) 20 Days

Session I B (June 15 - July 1) 17 Days

Session II (July 6 - August 10) 36 Days

Session II C (July 6 - July 22) 17 Days

Session II D (July 25 - August 10) 17 Days

If a medical single is required please contact Deborah Peacock at peacocdl@potsdam.edu for further information.

SUNY Potsdam