Residence Contract Extension Form

NOTE: SUBMISSION OF THIS FORM DOES NOT CONSTITUTE APPROVAL!
 If approved, the following conditions exist:

1. Extension is granted for only you (not roommates).
2. No guests are permitted except for other Loyola students with a contract extension.
3. All Loyola College policies are in effect.
4. Any violations of The Code of Conduct during the contract extension will result in sanctions, as well as being prohibited from receiving contract extensions in the future.
5. Failure to comply with the above conditions could result in immediate suspension of the contract extension.

Contract Extension Deadlines:

Name «
ID Number «
Campus Phone «
E-mail «
Building and Room Number «
Requested Date(s) of Extension: From «
To «
This extension is for the: «	-- Select from the following -- Thanksgiving: 11/21/2007 - 11/25/2007 Christmas / Semester Break: 12/21/2007 - 1/13/2008 Spring Break: 3/01/2008 - 3/09/2008 Easter Break: 3/20/2008 - 3/24/2008 End of the Year (Undergrad): 5/09/2008 End of the Year (Grad): 5/17/2008
Reason for Extension «	Academic Other
Explain the Reason You Need an Extension « Please be Specific
Fields marked with "«" are required.