14-15 tempe upper class-grad application - copy

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TEMPE CAMPUS 2014-2015 UPPER CLASS / GRADUATE

HOUSING PREFERENCE REQUEST FORM Complete Parts 1 Through 7

OFFICE USE ONLY

Admin Fee Verified:

Data Entry By/Date:

Part 1: Demographic Information Name (Last, First, Middle) * ASU Affiliate ID # **

Major * Campus* Gender

Tempe West Polytechnic Downtown Male Female

Permanent Address (number, street, apartment number) * Home Phone (include area code) *

( )

City, State, Zip * Country * Cell Phone (include area code) *

( )

ASU E-Mail Address * (This address must be used for all email communication with University Housing.)

Alternate E-Mail Address Emergency Contact Information

@asu.edu Name/Relation:

Please answer the following questions: Are you registered with the DRC and requesting special accommodations? YES NO

Are you participating in the American English Culture Program (AECP)? YES NO START DATE: ____ / ____ / ____ END DATE: ____ / __ / __

Home Phone: ( )

Cell Phone: ( )

Part 2: Room Choices University Housing will try to accommodate apartment choices but cannot guarantee these preferencesPlease select your top three (3) preferences by writing 1, 2, or 3 next to the desired options.

Arcadia Art & Design Community ___ Double (community bath)

University Towers Apartments ___ 2 Bedroom (2 People)

Barrett @ Vista ___ 2 Bedroom (2 People) ___ 3 Bedroom (4 People) ___ 4 Bedroom (4 People)

Barrett, the Honors College Community ___ Studio ___ Sustainable House at Barrett ___ Single (SHAB) Honors Community ___ Quad

Part 3: Plan Choices A. Meal Plan Options - Choose one meal plan option if desired/required or choose Upper class Do not want meal plan Unlimited + $250 M&G

Sparky 14 meals/week + $375 M&G

Barrett Unlimited + $100 M&G ^

Barrett Silver 12 meals/wk + 200 M&G ^

Maroon 180 meals/semester + $375 M&G

Gold 8 meals/week + $350 M&G

Barrett Platinum 14 meals/wk + $400 M&G ^

Barrett $1338/semester All M&G ^

All M&G - $1068/semester (Dollar for Dollar)

Upper class - Do not want meal plan

Barrett Maroon 150 meals/sem + $350 M&G^

^ All Students residing in the Barrett Honors College Community are required to select a Barrett Meal Plan. For more information on meal plans, visit http://sundevildining.asu.edu.

B. Payment Plan Select one option

PLAN 1: 1 payment per semester PLAN 2: 3 payments per semester*** If you are planning to pay with Financial Assistance, select Payment Plan 1. ***Payment Plan 2 will be billed a $25 non-refundable processing fee per semester. See Payment Plan Schedule at http://housing.asu.edu. Payment plan changes may be made online through July 15.

Part 4: Roommate Preference

Name: _________________________________________________ ASU Affiliate ID #: ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

No preference The request must be mutual with the correct ASU Affiliate number. Roommate requests are subject to space availability, cannot be guaranteed, and may not be honored. Roommates in a Residential Community must have majors in the same academic college. Roommate requests with incomplete information cannot be processed.

Please continue to Part 5 of the Housing Preference Request form

Denotes a default choice in cases where a preferred choice is not selected or may be unavailable.

* Denotes directory information that may be given out in response to general inquiry unless student submits a Withhold Directory Information Release form to the Registrars Office.

http://sundevildining.asu.edu/http://housing.asu.edu/https://students.asu.edu/forms/withhold-directory-information-requesttndesperHighlight

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tndesperTypewritten TextDue to limited housing, roommate preference not avaliable.

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TEMPE CAMPUS 2014-2015 UPPER CLASS / GRADUATE

HOUSING PREFERENCE REQUEST FORM Continued Name (Last, First, Middle) ASU Affiliate ID #

Part 5: Housing Living and Dining Confirmation payment

A $125 NON-REFUNDABLE Housing Living and Dining Request charge will automatically be charged to your ASU Student Account. Students can access their student account at my.asu.edu. Students can pay their ASU Account Balance by:

1. e-Check This is ASUs preferred method of payment. It is accessed through my.asu.edu by selecting the Make A Payment/QuikPay link. E-Checks are a fast and simple online payment method that can be made from regular U.S. checking and savings accounts.

2. Credit/Debit Card ASU does not directly accept credit/debit cards but has arranged with a third-party processor to accept MasterCard, Discover, and American Express payments online through QuikPay. This is accessed at my.asu.edu by selecting the Make A Payment/QuikPay link. All credit/debit card payments are charged an additional 2.5% service fee by the processor.

3. Mailed Check Checks should be payable to Arizona State University and must include the students ASU ID. Checks can be mailed to: Cashiering Services Arizona State University PO Box 870303 Tempe, AZ 85287-0303

4. Personal Check, Money Orders and Cash payments only are accepted in-person at Cashiering Services on all four Arizona State University campuses.

Part 6: Acknowledgements Please initial each of the following statements and sign below.

________ I have read, understand, and agree to all terms and conditions of the University Housing License Agreement.

________ I have read and completed parts 1 through 5 of the Living and Dining Confirmation Form and understand that my preference requests are not guaranteed.

________ I understand that if I decide not to attend ASU and/or live in on-campus housing, I must notify University Housing in writing. Notifying any other university office may not cancel your agreement and fees may be applied to your account.

________ I understand that University Housing will correspond with me via my official university e-mail address. It is my responsibility to check my university e-mail for communication from University Housing.

________ I understand that the $125.00 Housing Living and Dining Confirmation fee will be posted to my ASU student account and is due immediately.

PLEASE COMPLETE ALL 7 PARTS AND RETURN TO: ASU University Housing

P.O. Box 870212 Tempe, AZ 85287-0212

Phone: (480) 965-3515 Fax: (480) 965-1534 E-mail (for inquiries only): [email protected] http://housing.asu.edu

Rates and plans are subject to change. Please visit housing.asu.edu for updated rates and plans.

Please continue to Part 7 (the License Agreement) of the Housing Preference Request form

Student Signature: Date:

Legal Guardian Signature (if student is under age 18): Date:

https://my.asu.edu/https://my.asu.edu/https://my.asu.edu/mailto:[email protected]://housing.asu.edu/tndesperHighlight

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Part 7: HOUSING LICENSE AGREEMENT 2014 - 2015

University Housing - ARIZONA STATE UNIVERSITY

ASU University Housing P.O. Box 870212

Tempe, AZ 85287-0212

Fax (480) 965-1534

Name (Last, First, Middle) * ASU Affiliate ID # ** Date of Birth (month/day/year) *

_ _ / _ _ / _ _ _ _

ARIZONA STATE UNIVERSITY- UNIVERSITY HOUSING LICENSE AGREEMENT Upper class (non-first time freshmen) and Graduate students may apply for Housing; however, space is not guaranteed. All Arizona State University Housing residents must read and electronically or physically sign the University Housing License Agreement. If the resident is under 18 at the time they electronically or physically sign the License Agreement, a parent or Legal Guardian signature is also required. Parent or Legal Guardian signature authorizes the student to enter the Housing License Agreement, submit preference changes and access their residence hall room without need for further signatures. Parent or Legal Guardian signature also demonstrates understanding that their student is financially liable for all charges and bound by the License Agreement. A Housing Living and Dining Confirmation fee of $125.00 will be posted to the students ASU account at the time of signing or electronic submission and is due immediately. By signing this agreement, the student agrees to reside in on-campus housing for both the fall and spring semesters; the agreement binds the student financially for the entire academic year.

TERMS AND CONDITIONS The undersigned student agrees to payment of the $125.00 non-refundable Housing Living and Dining Confirmation Fee. ASU grants a license to the Student to reside in the assigned space. The relationship created by this license between ASU and the Student is that of licensor and licensee, and NOT that of landlord and tenant. The Student must be officially admitted and enrolled for credit-bearing coursework at ASU and be making satisfactory academic progress to live in the residence halls. ASU reserves the right to provide priority assignments to students who are classified as full-time and are in good standing in academic degree programs and whose conduct at ASU has not been determined by University Housing or the Office of Student Rights and Responsibilities to be incompatible with community living. The Student must officially check out of the residence hall if he/she is not enrolled in classes, withdraws or is withdrawn from ASU. Failure to do so will result in removal from the residence hall. ASU does not discriminate based on sex, race, color, sexual orientation, national origin, citizenship, religion, veteran status, age, or disability. Any Upper class or Graduate students living in traditional residence halls are required to carry a meal plan. Any students living in the Barrett, the Honors College Community are required to carry a Barrett meal plan. Only if a student is released from his/her University Housing License Agreement will the students meal plan be cancelled or financial adjustments made. Once the deadline for financial adjustments has passed (see the 2014-2015 Schedule of Charges and Deadlines), no room or meal plan adjustments will be made. Meal plan changes will only be processed during the meal plan change period at the start of each semester.

TERM OF THE AGREEMENT

The term of this agreement begins when a student submits this signed application to Arizona State University University Housing and continues until the residence halls close at the end of the spring semester; unless cancelled by ASU or the student prior to check-in, cancelled by breach, approved Housing Exception or by an approved License Agreement Release after check-in (see Schedule of Charges and Deadlines for valid reasons for License Agreement release). A separate agreement may be required for occupancy during the Winter Break period. Exceptions or changes to this agreement are not valid unless the Director of University Housing or his/her designee has confirmed them in writing.

THE STUDENT AGREES TO:

1. Know, observe and comply with the terms and conditions of this agreement, all federal and state laws, all ASU policies and regulations governing student conduct including the ASU Student Code of Conduct and University Housing Student Handbook, and the Computer, Internet and Electronic Communications Policy , mandatory meal plan, and any subsequent policies or regulations that ASU may adopt or publish during the term of the agreement.

2. Review the Schedule of Charges and Deadlines and make payments for all fees, living and dining charges, and any other additional charges for the applicable period.

3. Notify University Housing in writing of housing cancellation request by the stated deadlines; notification to other departments within the university does not constitute proper notification. Additional fees may apply for late submission of notice of non-attendance or cancellation notice as set in the Schedule of Charges and Deadlines.

4. Recognize that ASU is not liable for loss, theft, or damage of personal property. ASU does not offer insurance coverage for personal property. The student may privately obtain insurance coverage for personal property, if desired.

5. Maintain the assigned space in a safe manner and in good condition for the entire term of the agreement. Room furnishings shall not be removed or stored. Public area or lounge furnishings shall not be moved into a student's room. It is the students responsibility to restore the room to its original condition prior to check out.

6. Make appropriate arrangements for any necessary personal attendant care or vested service animals prior to the beginning of each academic term, if required due to students disability. The student has the sole financial responsibility for his/her own personal attendant care. Service animals will be approved on a case-by-case basis by the Disability Resource Center.

7. Move to a different room if required by University Housing staff for behavioral or administrative purposes.

8. Not sell, sublease, or assign the room to anyone at any time. Use of a room for commercial purposes is expressly prohibited.

9. Not move out of the residence hall without obtaining an approved License Agreement Release and officially completing the check-out process. A student vacating his/her assigned space without an approved written release from University Housing will be held responsible for the financial commitments of the entire term of the agreement, including the portion remaining after the student vacates the room.

Please continue to the next section of the agreement

http://students.asu.edu/srr/codehttp://housing.asu.edu/content/handbookhttp://www.asu.edu/aad/manuals/acd/acd125.htmlhttp://www.asu.edu/aad/manuals/acd/acd125.htmltndesperHighlight

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HOUSING LICENSE AGREEMENT 2014 - 2015

University Housing - ARIZONA STATE UNIVERSITY

ASU University Housing P.O. Box 870212

Tempe, AZ 85287-0212

Fax (480) 965-1534

Name (Last, First, Middle) * ASU Affiliate ID # ** Date of Birth (month/day/year) *

_ _ / _ _ / _ _ _ _

GENERAL PROVISIONS

1. ASU staff or other designated agents necessary to the operation of the residence halls may be authorized by the Director of University Housing to enter a students room at any time to verify inventory records or occupancy, perform maintenance, perform security investigations under the Computer, Internet and Electronic Communication Policy, or enforce safety, health, or ASU Code of Conduct standards.

2. University Housing reserves the right to change, cancel, or consolidate room assignments at any time due to academic ineligibility, discipline, safety, health, or administrative reasons.

3. University Housing reserves the right to terminate this agreement by written notice with due process if a student fails to comply with any terms and conditions of this agreement.

4. The Arizona Board of Regents, ASU, and/or designated facility management companies reserve the right to change room rates and other charges and fees if circumstances require adjustments.

5. University Housing may immediately terminate this license agreement for any purpose including but not limited to:

Behaviors that disrupt the residential community or the educational environment, including but not limited to: -safety and security of community to include harming or

threatening to harm oneself or others -Use, misuse, and/or possession of alcohol and/or other drugs

Outstanding account balances owed for student housing fees

REQUIRED VACCINE

The Measles vaccine (MMR) is the only required vaccination at ASU. Before a student can check in to his/her hall, the student is required to document via the MMR Immunization Form that he/she has had two measles vaccinations (one of which must be dated after 1979), or a lab test showing proof of immunity to the measles (rubeola). The MMR vaccine is available for a fee at any of ASU's health services locations. A student will see a MMR Immunization hold under "My Tasks" on My ASU until measles information is received and verified. The undersigned student understands that he/she will not be permitted to check into the room assignment if the MMR information is not updated with ASU Health Services at the time of check in.

ROOM KEY

The undersigned student agrees that upon check in, he/she becomes responsible and liable for the room key. It is the students responsibility to obtain and keep possession of the room key. If the key is lost or stolen, the Student understands that he/she will be charged applicable key replacement and/or lock change fees for each time a new key is issued and/or locks are changed. The Student understands that he/she is responsible for turning in the key at the time of check out, and if fails to do so, key replacement and/or lock change charges will apply.

MAILBOX SERVICES AGREEMENT

The undersigned student agrees not to use the mailbox premises or any center services for any unlawful, illegitimate or fraudulent purpose or for any purpose prohibited by US postal regulations. The Student understands that any use of the mailbox is for personal use only during the term of the license agreement with University Housing.

The Student understands that it is his/her responsibility to inform The UPS Store* of any change in status with University Housing. The Student requests that The UPS Store staff keep and sign for any letters, packages, parcels, etc. that may be received. The Student understands that he/she cannot hold ASU University Housing, The UPS Store, Mail Boxes, Etc., Inc. or their respective affiliates responsible for any damages or loss incurred to these items prior to delivery. The UPS Store will make every effort to secure these items until claimed. Items not claimed within 24 hours of notification may be returned to sender. All correspondence will be delivered to the students ASU provided email account.

The Student understands that the mailbox key must be returned to The UPS Store upon termination/expiration of this agreement; The UPS Store will then forward mail to the students registered, permanent address for 90 days in accordance with its agreement with ASU. Upon expiration or termination of this agreement, students MUST officially check out of the residence hall and provide a mail forwarding address via My ASU. The Student agrees to return the mail key within 3 business days of official check out to The UPS Store or else re-keying charges will be applied to the students ASU Student Account. The Student understands any lost keys must be reported to The UPS Store immediately for replacement; replacement charges will apply.

*Mail distribution at West and Downtown Phoenix campuses are not handled by The UPS Store

Student Signature: Date:

Legal Guardian Signature (if student is under age 18): Date:

http://students.asu.edu/forms/measles-immunization-formhttp://students.asu.edu/forms/measles-immunization-formtndesperRectangle

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14-15 tempe upper class-grad application - copy

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