Piedmont College

Summer Housing Request Form

Today's Date: date selector First Name: Last Name: Date of Birth: Major: Hometown (City & State): Cell Number: Lions Email: Gender: Male Female Are you working on campus? Yes No If 'Yes,' where on campus will you be working? Have you had any violation on campus or with residence life? Yes No If 'Yes,' please explain: Have you registered for Summer Classes? Yes No Please explain your reason for requesting summer housing. Start Date: date selector End Date: date selector Rooms are billed at the rate of $40/week, and the deadline is April 15th.