Student ID Number: Room Number: Student Housing: Tenth Street Kekuli House
WINTER BREAK
EXTENSION FORM
Within Reach. Beyond Imagination.
1 888 953 1133 selkirk.ca
Last Name: First Name: Initial:
Requested Date: Date (Conrmed by Oce):
Tenth Street, Student Housing
702 Tenth Street
Nelson, BC V1L 3C7
Phone: (250) 505-1393
SPECIAL TERMS, CONDITIONS AND RULES
If you are applying to stay in Student Housing for any portion of the winter break, please note that while the Student Housing Agreement is still
in eect, there are some additional terms, conditions and special rules:
1. If you have accumulated any behaviour points during the Fall Semester, you will not be considered to stayover during winter break.
2. Student Housing supervision and services are limited. The Housing Advisor on Duty’s Number will be posted at the Front Desk, and can
be contacted in the case of an emergency. There will be Student Housing Staff available 24 hours a day.
3. No guests will be permitted under any circumstances. This rule is strictly enforced for the safety of students and Student Housing sta, as
well as the general up-keep of the Student Housing building.
4. Twenty-four hour quiet hours are in eect at all times. There will be one warning given for excessive noise and any further problems will
result in your removal from Student Housing for the remainder of the Winter Break.
5. Sta may enter rooms at any time. Suite inspections and annual preventative maintenance will be taking place for all suites. Sta or
security may enter suites if they suspect any potential violations of Student Housing and/or winter break rules.
6. Suite doors must remain closed at all times. They cannot be propped open.
NOTE: All Student Housing services will not be operating, ie mail, snow removal, campus and oces will be closed. The fee for the additional days during
this time period is $250 and must be paid in advance. Winter break stay-over fees are non-refundable.
WINTER BREAK REQUEST
Please outline below your need for accommodations during this time. Please attach any additional information that may help us in understanding your needs.
By signing below, I understand that remaining in Housing during Winter Break is a privilege and failure to abide by these special terms and conditions will
result in sanctions, which may include an eviction from Housing
. I understand that there will be absolutely no exceptions to these rules.
I agree that I have read and understand the above listed conditions and responsibilities
Applicant Signature
Approving Manager Signature Manager Name
STUDENT
HOUSING
OFFICE USE ONLY
Request Accepted Payment Method:
COMMENTS:
Date Received:
Request Denied
Payment Recived
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome