* 1. What is your first name?

* 2. What is your last name?

* 3. What is your gender?

* 4. As of March 2013, what is your student classification?

* 5. Reason for requesting summer housing:

* 6. What is your Harvard email address?

* 7. What is your non-Harvard email address?

* 8. I currently live in the following dorm/apt:

* 9. My dorm or apartment number is:

* 10. The first day students can move into summer housing is May 31, 2014, although students can move in any day after that. What is your anticipated move in date to summer housing?

* 11. Students must be moved out of summer housing by 8/3/2014. However, students can choose any date prior to August 3rd as their move out date. What is your anticipated move out date?

* 12. Please indicate any other needs or preferences you have for your room (i.e. disability needs, floor requested, etc).

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