Student Housing Damage Charge Form
Cleaning, damages, missing/broken keys (one per item/charge). If charges split between students one form per student with split amount (ex - lock change $150 split between 2 students $75 listed on each student form).
Staff Name
*
First Name
Last Name
Student Name
*
First Name
Last Name
Residence Hall
*
Anderson
Jorgenson
Rimview
Widenhouse
Student Room Number
Student Room Letter (Rimview ONLY)
*
A
B
C
D
Rimview suite main door
Not a Rimview Room
Work Order Submitted
*
Yes
No
Detailed description of charge (same language as work order) - yep don't forget to put in the work order
*
Photos of items being charged for
*
Browse Files
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of
Date of charge staff discovery (damage, cleaning, broken/lost key)
*
-
Month
-
Day
Year
Date
Estimated Charge from Price Sheet ($#.##)
*
Staff Notes
*
Submit
Should be Empty: