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Closing Extension Forms from SUNY- Stony Brook

Division of Campus Residences
M E M O

TO:
FROM:
RE: Extension Request Reply
DATE:
vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv
Your request for an extended stay has been received and reviewed. After careful consideration by the Quad Professional Staff, your request for an extended stay has been denied. Please make arrangements to leave 24 hours after your last exam or by Tuesday, May 16, 2000 at 10pm (which ever comes first).

If you are found to be in the residence halls without approval, you will be subject to judicial action, the cost of intersession housing and you will be immediately escorted out of the residence halls. Please see me if you have any questions.

Division of Campus Residences
M E M O

Division of Campus Residences
Extension Request Form

If you are requesting to remain in the residence halls beyond 24 hours after your last final exam, please complete the form below and return it to your Residence Hall Director (RHD) no later than Thursday, May 4, 2000. Once your request has been reviewed, your RHD will contact you regarding the decision. Please note that no extension will be approved for later than 9:30 am on Wednesday, May 17, 2000.

Name ____________________________________________ Social Security Number ________________________

Room/Building ___________________________________ Campus Phone 216- ___________________________

Permanent Address ______________________________________________________________________________
Number & Street Apartment #

City State Zip

Date & Time of Last Final ___________________________ Class ________________________________________

Requesting Extension Until _____________________________________________ (no later than 9:30am on 05/17)

Reason for Requesting Extension ____________________________________________________________________

Student Signature _________________________________ Date _________________________________________

Office Use Only

Date Request Received _______________________________________________________________

The request for extended stay has been:
_____ Approved. The resident may stay until __________________________________________
_____ Denied. Reason(s) for denial ___________________________________________________

_____________________________________________________________________________

Date response sent to student _____________________________ Method ___________________

RHD Signature __________________________________________ Date _____________________

Division of Campus Residences
M E M O

TO:
FROM:
RE: Extension Request Reply
DATE:
vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv
Your request for an extended stay has been received and reviewed. After careful consideration, the Professional Staff has approved your request for an extended stay. You are permitted to remain in your residence hall until (day) _______________________________________ at (time) __________________________ .

You are required to adhere to the following regulations during your extended stay. Failure to do so may result in an immediate revocation of your extension and judicial action being taken.

v You must carry this pass with you at all times.
v You must adhere to all University and Campus Residences policies and procedures.
v 24 Quiet Hours remain in effect until 9:30am on Wednesday, May 17, 2000.
v No guests are permitted.
v No parties are permitted.

RHD Signature _____________________________________________ Date ________________________________

Division of Campus Residences
M E M O

TO:
FROM:
RE: Extension Request Reply
DATE:
vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv
Your request for an extended stay has been received and reviewed. After careful consideration, the Professional Staff has approved your request for an extended stay. You are permitted to remain in your residence hall until (day) _______________________________________ at (time) __________________________ .

You are required to adhere to the following regulations during your extended stay. Failure to do so may result in an immediate revocation of your extension and judicial action being taken.

RHD Signature _____________________________________________ Date ________________________________

The content on these pages was originally provided by Brian C. Steinberg, the founder of http://www.theallygroup.org and http://www.safezoneforall.com (Creater of the previous: http://www.residentassistant.com/reslifepro)