Full Name: University ID:

Student Argus E-Mail Address:

Current
Bldg/Room: Phone: P.O. Box

Terms and conditions of Winter Break Housing:

Break Housing requires a payment of $320.00 due on or before December 14, 2012. The Break Fee will be charged to your UWF Student Account within 24 hours of submitting this form online. After that time, the fee can be paid in person at the UWF Cashier's Office, Building 20E, or by accessing your UWF Student Account. Break Housing will be in your assigned space for Spring 2013. The term for Break Housing is December 15, 2012 - January 4, 2013. All Break Housing residents pay for the entire break term no matter how many nights they anticipate staying.

• Resident lived on-campus Fall 2012
• Resident does not have a past due Housing balance
• Break Contract is received and Break Fee is paid by December 14, 2012
• Resident with a pending student conduct case or conduct hold must contact the Housing and Residence Life, Central Office, Building 21, for approval prior to submitting Break Contract and paying Break Fee.

• "By submitting this form electronically, I agree to abide by all Department of Housing and Residence Life policies and procedures as well as all University regulations during Break Housing. Failure to follow policies and procedures will result in immediate removal and conduct action. I understand that standard University Housing services are limited for the period of this Break Housing assignment term. Services which may be limited include: staff availability, evening and weekend Area Office coverage, University Housing Maintenance services, Dining Services provided by Chartwells, and UWF Trolley Services. I further understand that a Break Housing Assignment is contingent upon payment in full of Break Housing Fee."

• By submitting this form electronically, I attach my electronic signature to this form and I understand this fee will be posted on my UWF Student Account in the amount of $320.00, to be paid at the UWF Cashier’s Office, Building 20.