IPFW Student Housing
SPRING 2017 TEMPORARY EXTENSTION
REQUEST
Student/Resident Name
Phone #
Address
City
State, Zip
Student ID #
Date Requested to Move In:
Reason for Early Arrival:
Spring Move Out: May 7th by 5pm
Early Arrival Daily Rates
# Days Requested
4 Bed, 4 Bath
$36.26
$30.92
$26.12
$23.09
$26.07
4 Bed, 2 Bath
$20.61
3 Bed, 2 Bath Private
$20.92
3 Bed, 2 Bath Shared
$17.52
1 Bedroom
2 Bed, 2 Bath Deluxe
2 Bed, 2 Bath
2 Bed, 1 Bath
Total Cost
Note: Early move in fees need to be made prior to or on approved move in date.
Payments can be made by Check, Credit Card, or Money Order
Signature of Resident
Date
FOR OFFICE USE ONLY
Approved
Student Housing
4010 W. Housing Dr.
Fort Wayne, IN 46815
Phone: (260) 481-4180
Fax: (260) 481-4182
Date