Keyword:

Student Information

*First Name: *Last Name:

*Brandeis Email Address:

*Sage ID #:

*Year of Graduation: 2008 2009 2010 2011

*Mailbox #:

*Phone #:

Spring '08 Housing:
*Quad: 567 South St. Castle Charles River East Massell Mods North Rosenthal Village Ziv Off-Campus Building: Room #:

Fall '08 Housing:
*Quad: 567 South St. Castle Charles River East Massell Mods North Rosenthal Village Ziv Wait List Off-Campus Building: Room #:

Students needing transitional housing after commencement or before the fall semester should complete the separate transitional housing request form, available here.

Summer Employee Housing is $120.00/week. No prorating. Complete week runs Monday through Sunday.

Apartment-mate Request: (All parties must request each other)

If there is special information that will help us with matching you with apartment-mates, please state it below:

Sponsoring Department Information

*Department Name: *Mailstop:

*Name and Title of Direct Supervisor:

*Supervisor's Email:

Summer License Agreement

• I, the student named above, hereby request assignment to a Brandeis University residence hall during the summer for the dates listed above.
• I agree to pay the room rate of $120 per week for the space to which I am assigned.  The room rate DOES NOT include custodial services or a meal plan.  I will be responsible for the cleanliness of my living space and any meals during my stay. 
• I understand that I will receive a room key only after I have signed this license and have my sponsoring department assign a charge-line.  The key and room are not transferable to any other person. Keys not returned within 24 hours of my indicated end date will result in a $60.00 replacement key charge that will be billed to my account.
• I understand that no space is available prior to 10:00 AM on Tuesday, May 27, 2008. I agree to have vacated the hall by noon on Fri., August 8, 2008.   I understand that if I have not vacated the hall by the specified time, the appropriate steps will be instituted to remove me and my personal property from the premises.  These steps may include charges for removal of property, lock changes(s), or charge for room use.
• I affirm that I am not enrolled in the Brandeis Summer School or any other Brandeis Summer Program for which alternative housing is offered. 
• I understand that this license is for one occupant only.  Guests staying for an extended period of time are not permitted. 
• The assignment of residence space does not involve a tenancy of any kind and may be revoked at the discretion of the University at any time.
• I agree to fill out an entering RCR (Room Condition Report) and exiting RCR with my Summer CA.
• I have read and agree to abide by the terms and conditions listed on this license, together with the rules, regulations, and procedures of Brandeis University as published herein and in Rights and Responsibilities.  If I am under the age of 18, this license must be signed by my parent or legal guardian as guarantor who will then be liable for fulfilling the obligations of this license.
• I understand that failure to abide by these terms or Rights and Responsibilities may result in immediate termination of this license.
• The license applies to the dates specified in this contract.  I am responsible and liable for occupancy during and costs associated with this period of time.  This license may be terminated or extended under special circumstances by a licensee’s written request if received by the Department of Residence Life 10 working days prior to your departure.  Failure to meet this deadline will result in full billing for the dates listed for requested occupancy.
• The Sponsoring Department must indicate a chart string for billing purposes and collect reimbursement from the student.  The Department of Residence Life is not responsible for collection of student payments.  The sponsoring department will be billed for the full amount at the end of the summer.

*By checking this box, I agree to the above license agreement.