Winter Break Departure Notification Form

Winter Break Departure Notification Form

Please complete this form as you leave campus housing for winter break so you room can be added to the empty room list and inspected by staff.
EACH ROOMMATE MUST COMPLETE THIS FORM!
Name*

First NameLast Name
Email*
example@example.com
Residence Hall*

AndersonJorgensonRimviewWidenhouse
Room Number*
I verify as a student not registered for winter break housing I have vacated campus housing by the day after last date of finals at noon deadline.

Before my departure, I verify I have completed the closing checklist items listed below.

I understand a member of the Residence Life team will be entering my room to ensure all items on this list have been completed. Any violation of policy discovered during this room check will be documented and processed through the student conduct system.
CLOSING CHECKLIST (all must be completed as part of check out)*

Room is detail cleanedSet the thermostat to auto/on HEAT @ 60 degreesClose and LOCK windowsClose window shadesRemove all trash and dispose of it in dumpsterUnplug all electronics INCLUDING ALARM CLOCK (refrigerators can be left plugged in but ALL items must be removed)Remove all food items NO FOOD CAN BE LEFT IN THE ROOM THIS INCLUDES NON-PERISHABLES, PERISHABLES, AND FROZEN ITEMSTurn off lightsClose and LOCK doorCheck your mail - it will not be forwarded over breakHave a pet fish, plant, ESA or Service Animal? Take it and all necessary care items with youIf you have a bike put it in your room - this will help reduce your chance of it being stolen or damaged.If you are leaving a vehicle on campus check with the Office of Campus Safety to ensure it is parked in an approved winter break lot/spot so as to not interfere with snow removal schedules. Remove any valuable items – this will also help reduce theft of the items.Have an open spot in your room? If so, make sure it is free and clear of all personal items to allow a new student to move in.
Signature*

Clear
EACH ROOMMATE MUST COMPLETE THIS FORM!
Should be Empty:

Winter Break Departure Notification Form

EACH ROOMMATE MUST COMPLETE THIS FORM!

EACH ROOMMATE MUST COMPLETE THIS FORM!