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 $75 listed on each student form).
Below is an outline of discovered/reported damages to a space to which you were assigned. Associated charges for the replacement/repairs for these items have been posted to your student account. Please contact housing@rocky.edu if you have any questions.
SEND NOTICE TO STUDENT
Staff Name
*
First Name
Last Name
Student Name
*
First Name
Last Name
Student Email
*
example@example.com
Residence Hall
*
Anderson
Jorgenson
Rimview
Widenhouse
Student Room Number
Student Room Letter (Rimview ONLY)
*
A
B
C
D
Rimview suite main door
Not a Rimview Room
Work Order Submitted
*
Yes
No
Detailed description of charge
*
Photos of items being charged for
*
Browse Files
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of
Date of charge staff discovery (damage, cleaning, broken/lost key)
*
-
Month
-
Day
Year
Date
Estimated Charge from Price Sheet ($#.##)
*
Staff Notes
*
Submit
Should be Empty: