Staying for Breaks Form
Name
*
First Name
Last Name
W Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
Must be your WNMU Email
Building
*
Please Select
Centennial Hall
Mustang Village AN
Mustang Village AS
Mustang Village B
Mustang Village C
Muir Heights
Room Number
*
Which break do you plan on staying for?
*
Please Select
Fall Break 2024
Winter Break 2024
Spring Break 2025
Which break(s) do you plan on staying for?
Fall Break 2025
Winter Break 2025
Spring Break 2026
Please select the dates of which you will be staying on campus for Winter Break 2024.
Start Date
*
-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
I understand that campus is closed during this break.
*
Initial Here
I under that during this time, there are no on-campus dining facilities open and Housing staff are not responsible for providing meals options for me.
*
Initial Here
I understand that despite there being no dining facilities open, the Housing policies regarding cooking appliances still apply to me.
*
Initial Here
I understand that there will still be Housing staff on campus during these breaks and they are permitted to conduct room checks.
*
Initial Here
Signature
*
Submit
Should be Empty: