* Required

First Namerequired

Last Namerequired

Student ID#required

Cell Phone #required

Hall & Room #required

Known Food Allergies or Dietary Restrictionsrequired

DAMAGE/CONDITION

Desk/Dresser Damage*

Yes No

Please describe in detailrequired

Bed Frame Damage*

Yes No

Please describe in detailrequired

Matress Damage*

Yes No

Please describe in detailrequired

Table/Chairs Damage*

Yes No

Please describe in detailrequired

Couch/Loveseat Damage*

Yes No

Please describe in detailrequired

AC/Heater Unit Damage*

Yes No

Please describe in detailrequired

Window (Glass, Blinds, Screens) Damage*

Yes No

Please describe in detailrequired

Door Damage*

Yes No

Please describe in detailrequired

Lock Damage*

Yes No

Please describe in detailrequired

Ceiling Damage*

Yes No

Please describe in detailrequired

Light Fixture Damage*

Yes No

Please describe in detailrequired

Wall (Including outlets & light switches) Damage*

Yes No

Please describe in detailrequired

Flooring Damage*

Yes No

Please describe in detailrequired

Kitchen (Cabinets, Countertops, Fridge, Stove) Damage*

Yes No

Please describe in detailrequired

Bathroom (Shower/Tub, Sink, Toilet) Damage*

Yes No

Please describe in detailrequired

Closet Damage*

Yes No

Please describe in detailrequired

Misc Damage*

Yes No

Please describe in detailrequired

By providing my initials, I electronically sign and agree to the following:

I have checked this residence hall room for the furnishings listed and for any damage to the above items.
I will pay for damages not documented on this check-in sheet at the time I check out.
I have received a Residence Hall Handbook and I agree to abide by all Policies & Procedures as printed in the Handbook.

Initialsrequired

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