First Name:          

Last Name:          

Longwood ID #:   L

Date of Birth:      

Gender:               Select One: Male Female

Longwood Email Address:

Local Address:

Street/Box:    
City:              
State:             
Zip Code:        

Permanent Address:

Street/Box:    
City:              
State:            
Zip Code:       

Cell Phone Number:   

Cox Hall is the only Longwood-managed accommodations offered for the 2011 Summer School Classes. Assignments will be processed in the order in which they are received by RCL and will be honored as space permits.

From & To*:

Course(s)*:

Start Date of Course*:  

End Date of Course*:    

Start Date of Course:  

End Date of Course:    

Start Date of Course:  

End Date of Course:    

Start Date of Course:  

End Date of Course:    

Specialized Housing: YES NO
if YES - please contact Disability Support Services (434.395.2391 x 711 {TT Relay})

Specialized housing requirements

Mutual Roommate Request: YES NO

Mutual 1:
Mutual 2:
Mutual 3:
Mutual 4:

Please note that Cox Hall provides Double Occupancy Rooms.

By submitting this 2011 Summer School Housing Application, I am officially asking to be provided housing and a meal plan, during the indicated summer period. I authorize that all associated charges be applied to my student account. I understand that I am financially responsible for making timely payment, prior to the start of each indicated summer school period.

I further understand that I am financially responsible for any damages that occur within my assigned space/area.

Cancellation of this 2011 Summer School Application must be submitted in writing, three (3) days before the first day of your classes.

I understand that RCL will verify all the information on this application and intentionally falsified information will be considered a violation of the Longwood University Honor Code.

Select "Yes" to agree to terms and continue YES