Housing and Residence Life
Holloway Hall

Semester Break Contact Information Form - Sea Gull Square

Dear Sea Gull Square Student,

As the residence halls close across campus and the university will be closed between December 23, 2011 through January 2, 2012, housing protocol calls for the inactivation of student Gull Cards to the exterior doors.  In order to ensure the reactivation of your card upon returning to Sea Gull Square, you must complete the following information.  Indicate below the dates you will be leaving and returning from your break.  This will also assist our office in the event of an emergency.

Thank you!

* * *

Contact Information                                                                 * required field

*Are you staying on campus over the break? Yes
No
   
*First Name:
*Last Name:
 
Date of Departure:
Date of Return to SU:
   
Address of where you will be staying during the break:
Address:
Address2:
City:
State:
Zip: 
Student Telephone Number:
   
Emergency Contact Person:
Relationship:
Telephone Number: