Commuter Room Request Form



Personal Information - All fields are required
Last Name:
First Name:
Address:
City:
State:
Zip Code:
Phone Number:
Email Address:
Gender:
Student ID #:
GGBTS Campus:
Room Information - All fields are required
All rooms are double occupancy ($15 per person, per night). Roommates will be assigned from the Residence life office. However, you may request a specific roommate here (we recommend your preferred roommate request the same via their own Commuter Room Request form). All room charges are billed to credit card accounts at the end of each month. Please check one:


Semester Reservation Dates
Please write down specific DATE/NIGHT (for overnight stay) you require through the entire course of the semester. Cancellations MUST be made 24 hours in advance of check-in time.

Month Date(s) Total Nights
January
February
March
April
May
June
July
August
September
October
November
December

Billing Information - All fields are required
A credit card is required to process and hold this reservation. You will receive a confirmation email indicating that your request has been processed.
Card Type:
Card #:
Expiration Date:
V-code:
(last 3 #s on back of card)

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