Check-Out Extension Request

This form is only for current resident use. Please read the following carefully:

I am a current resident and student at OSU Institute of Technology, and I understand that I must follow all the policies and procedures as I would during an in-session period of any semester. NO VISITORS OR ALCOHOLIC BEVERAGES ARE ALLOWED ON CAMPUS DURING THIS TIME. I also understand that if a policy is violated the permission and privilege of having an extension to check out which can result in immediate removal from the Residence Hall areas. Also, I understand that I may be subject to the student conduct process for any policy violations.

Note that submitting this form does not guarantee approval for request.

Name Name First Last
CWID

Student ID Number
Please list campus residence

Building and room number.
Phone Phone - ### - ### ####
University Email
Requested Check-Out Date Requested Check-Out Date / MM / DD YYYY
Please explain the reason you should be considered for a check-out extension.