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 23 - June 27) 36 Days

Session I A (May 23 - June 10) 19 Days

Session I B (June 12 - June 27) 16 Days

Session II (July 8 - August 9) 33 Days

Session II C (July 8 - July 23) 16 Days

Session II D (July 25 - August 9) 16 Days

If a medical single is required please complete the Medical Housing form found on our website.

SUNY Potsdam