Under 18 Consent Form

Under 18 Parent Consent for Housing and Dining License Agreement Form
2014-2015 Academic Year

Thank you for applying to live on campus at Wayne State University! Please utilize this form to discuss the preferences that you chose on your online housing and dining application with your parent or guardian. After you have read and discussed this license agreement fully, both you and your parents will need to sign it and return it. After the document has been signed, please return it to the Office of Housing and Residential Life by either mail at: The Office of Housing and Residential Life, 5221 Gullen #598, Detroit, MI 48202 or by fax at (313) 577-6644.

First name: Last name: Middle Initial:

Nine digit Banner ID number: WSU Access ID:

Permanent Street Address:

City: State: Zip: Country:

Date of birth:

Parent name:

Parent email:

RESIDENCE HALL AND FURNISHED APARTMENT
HOUSING AND DINING LICENSE AGREEMENT

HOUSING DATES OF OCCUPANCY:

A. I understand that my Housing License Agreement provides occupancy for an assigned space in campus housing starting on August 23, 2014 and ending on May 6, 2015.

B. I understand that I may not move into my assigned space prior to August 23, 2014 or remain in my space after May 6, 2015.

C. I understand that if I need to extend my dates of occupancy for the reasons listed below a written request must be submitted to the Office of Housing and Residential Life. If space is available and my request is approved I will be charged a per-day fee of $20.

a. My program’s academic calendar differs from the specified occupancy dates.

b. I have an academic commitment (i.e. graduation or orientation) that requires me to be on campus.

c. I have an official athletic commitment as required and arranged by my coach.

D. I understand that the full terms of this license agreement will be enforced should I move in prior to August 23, 2014 or remain in my space after May 6, 2015.

E. I understand all University Housing remains open to residents continuously during the dates specified above except for Atchison and Ghafari Halls, which will be open to residents during the dates above except for the following closure: Semester Closure - Wednesday, December 17, 2014 at noon until Sunday, January 11, 2015 at noon.

DINING PLAN:

A. I understand all dining plans begin on August 24, 2014 and end on May 5, 2015. All students living in a residence hall must choose a meal plan.

B. I understand meals will not be provided during the University break period of Thanksgiving Break (November 26, 2014 – November 30, 2014), Semester Break (December 17, 2014 – January 11, 2015) and Spring Break (after lunch on March 15, 2015 – March 22, 2015). Only a brunch meal period and a dinner service meal period will be made available in the dining halls on Labor Day, September 1, 2014 and Martin Luther King Day, January 19, 2015.

C. I understand that a request to alter or to receive an exemption from a dining license agreement due to medical or special needs must be submitted in writing to the attention of the Office Housing & Residential Life, Wayne State University, 5221 Gullen Mall, Suite 598, Detroit, MI 48202. Requests must be accompanied by appropriate documentation.

D. I understand that failure to use a dining plan or failure to make a payment does not cancel my financial obligation.

E. I understand that there is a meal change period at the beginning of each semester and one at the end of the fall semester to accommodate any changes in my class schedule.

F. I understand that if I request a meal plan change or cancellation and it is approved I will be billed and prorated appropriately from the effective date of change.

G. I understand that residents in Deroy furnished apartments may select a meal plan but it is not required.

H. I understand that if I am a freshman I can only pick a Warrior Pass 50, Warrior Pass 225 or a Warrior Pass 400 meal plan.

HOUSING AND DINING FEES:

A. I understand that I agree to pay the University the amount set by the WSU Board of Governors for my room and meal plan beginning at the start of my license agreement, which is August 23, 2014 or as of the date that I am assigned if my license agreement is submitted after August 23, 2014, until the end of my license agreement which is May 6, 2015.

B. I understand that if granted permission for special circumstances to arrive prior to the start of my license agreement or remain on campus after my license agreement has ended, I may be subject to additional charges determined by the Office of Housing and Residential Life.

C. I understand that failure to utilize the assigned space or the meal plan does not cancel my financial obligation.

D. I understand room and meal plan charges are billed by semester and are due prior to the first day of classes each semester.

E. I understand when submitting my license agreement I will pay a $100 non-refundable application fee.

F. I understand that if I am removed from housing or the University I am responsible for my housing and dining fees for the remainder of the academic year.

G. I understand that failure to pay my housing and dining fees in full may result in removal from my room and I will still be responsible for all of my housing and dining fees for the remainder of the academic year.

ROOM ASSIGNMENTS:

A. I understand that my room/suite/apartment preferences will be considered, but may not be able to be accommodated. The Office of Housing and Residential Life has the sole right to make assignments in campus housing.

B. I understand the Office of Housing and Residential Life has the right to determine the occupancy of any room/suite/apartment, fill any vacancies and approve room changes or reassignments.

C. I understand that The Office of Housing and Residential Life may change my room assignment at any time if the University deems it to be in the University's best interest or in the best interest of the student.

D. I understand that if I am reassigned at the discretion of the University, I will be charged/prorated for the room/suite/apartment at the rate of the lower cost room/suite/apartment.

E. I understand that the University reserves the right, with no liability, to store, for a limited period of time, or discard any belongings remaining in a housing unit or facility if the housing assignment has not been vacated by a prescribed time or has been reassigned to another student.

F. I understand that only assigned persons are permitted to reside in campus housing.

G. I understand that Housing and Residential Life staff may consolidate students without roommates in order to accommodate other students.

H. I understand that if I’m assigned to a 24 Hour Quiet Hour Floor that I must sign and abide by the 24 hour quiet hour policy in which I cannot have audible sound coming from my room.

I. I understand that if I need any special accommodations for a documented medical reason it is my responsibility to inform the Office of Housing and Residential Life of my needs on the online license agreement at the time that I sign my license agreement. I also understand that the Office of Housing and Residential Life may consult with other University Offices to determine what appropriate accommodations are needed.

J. I understand that Wayne State University does not have any reports or record pertaining to the presence of lead-based paint except in Chatsworth Apartments. I acknowledge that I have reviewed the pamphlet entitled "Protect Your Family from Lead in Your Home", online at http://epa.gov/lead/pubs/leadpdfe.pdf.

CANCELLATIONS:

A. I understand that I do not have the right to cancel this license agreement unless I meet one of the following reasons:

a. I can cancel for any reason up until June 30, 2014.

b. I can cancel for any reason within 14 calendar days from the day I signed my license agreement. I understand that after I have checked in and picked up my key to my residence hall or furnished apartment space that the 14-day cancellation period no longer applies.

c. I can cancel if I graduate or I am no longer an enrolled student at the University. (Please note that enrollment in online courses or satellite campus courses count as being an enrolled student.)

d. I can cancel if I participate in a student teaching assignment that is farther than 40 miles from WSU’s Detroit campus.

e. I can cancel if I participate in an out-of-state or out-of-country internship, co-op, or study abroad program.

f. I can cancel if my medical documentation proves I developed a medical condition after signing my license agreement that campus housing cannot accommodate and prohibits living on campus. (Please note that the medical condition must be the student’s and not a family member or a friend.)

B. I understand that if I am approved for cancellation because I am no longer a registered student, and I re-enroll at the university, my license agreement will be reinstated and I will be responsible for housing and dining fees.

C. If approved for cancellation, I understand that I will be charged for my housing and dining fees until the date I complete a proper checkout of my assigned space.

D. If I am not approved for cancellation I understand that I am liable for all my assigned charges for both my fall and winter semester as indicated on this agreement.

E. I understand that, if I am permitted to cancel my Residence Hall/Furnished Apartment and Dining License Agreement for any reason, I will forfeit the entire $100 non-refundable application fee.

F. I understand that if I am academically dismissed or medically withdrawn from the University it is my responsibility to request to cancel my license agreement by submitting a license agreement cancellation to the Office of Housing & Residential Life.

G. I understand that in the event that I elect to move into off campus housing and/or turn in my keys to the front desk during the term of this license agreement while still an enrolled student I remain responsible for all license agreement charges for housing and dining (if applicable) for the 2014-1015 academic year.

H. I understand that all cancellation requests must be submitted to the Office of Housing and Residential Life, Wayne State University, 5221 Gullen Mall, SCB 598, Detroit, Michigan 48202 using the License Agreement Cancellation Request Form.

ELIGIBILITY:

A. I understand that if I am not a registered student after the University’s drop/add date of September 11, 2014 and January 27, 2015 I cannot live in University residence halls and furnished apartments and I will be expected to vacate my room within 24 hours.

B. I understand that if I am not a registered full time student and I violate any housing policies, the Office of Housing and Residential Life has the right to cancel my license agreement.

C. I understand that if I am not a registered full time student and space is needed for a full time student, the Office of Housing and Residential Life has the right to cancel my license agreement.

D. I understand that if I am removed from the University for academic or disciplinary reasons, a verified withdrawal or leave of absence, I will be required to vacate my room within 24 hours.

COMPLIANCE WITH GUIDELINES AND REGULATIONS:

A. I understand that I am agreeing to abide by all rules and regulations established by the Office of Housing and Residential Life, the Office of Dean of Students, and the individual living units. I understand that copies of Wayne State University Student Code of Conduct and the Community Living Guide are available to me through the WSU website and in hard copy, upon request. The Community Living Guide is the Office of Housing and Residential Life’s official document that outlines all of the rules and regulations of living in University housing.

B. I understand that the University reserves the right for authorized representatives of the University to enter an accommodation at a reasonable time and upon reasonable notice to perform cleaning, maintenance or inspection; or to enter whenever there is immediate or serious threat to the safety, health or well-being of persons or property or reasonable cause to believe there is a violation or suspected violation of University rules or regulations.

C. I understand that all public and private spaces in Atchison Hall, Ghafari Hall and The Towers Residential Suites are smoke-free living environments. All public spaces in DeRoy, Chatsworth and University Towers Apartments are smoke free environments.

D. I understand that all keys issued by the Office of Housing and Residential Life are the property of the University. I also understand that I cannot exchange, or give my key to another person nor duplicate my key.

E. I understand that I am responsible for keeping my living space in the same condition it was in when I moved in. I also understand if any damage occurs in my living space I will be charged to restore the damage.

F. I understand if any damage occurs in common areas I will be charged an equal share along with all other residents on the floor/suite, if a responsible party is not identified.

G. I understand that University email is the official means of communication from the Office of Housing and Residential Life and it is my responsibility to read, respond and follow all communication sent to me via my Wayne State email.

H. I understand that if my assigned space is destroyed or damaged in such way where it prevents the use of the facility (i.e. strike, public emergency, natural disaster, riot or other unforeseen circumstances) beyond the control of the University my license agreement may be terminated at the discretion of the Chief Housing Officer and I will be responsible for the prorated charges to the date of the termination.

I. I understand that the Office of Housing and Residential Life has the right to use any photographic image taken of me while in any public spaces, grounds, offices or University sponsored events at the University. I also understand that the Office of Housing and Residential Life has the authority to use my photographic image in all marketing materials (i.e. print materials or online advertising). If I do not want to have my photographic image used by the Office of Housing and Residential Life I must submit my request in writing to the Office of Housing and Residential Life, Wayne State University, 5221 Gullen Mall, SCB 598, Detroit, Michigan 48202 or via email at housing@wayne.edu.

J. I understand that I am responsible and liable for any and all injury and damage to persons or property caused, directly, or indirectly, by me or my guest’s intentional or negligent acts or omissions (including injury or damage caused by student defective property). I also understand that the University is not responsible.

K. I understand that I am responsible and liable for insuring my personal property, including losses due to fire, smoke, water, theft, defective wiring or any other unforeseen occurrence beyond the control of the University. I also understand the University is not responsible or liable for any loss or damage to my personal property and does not provide any property or liability insurance coverage for my benefit.

L. I understand that The Office of Housing and Residential Life has the right and may terminate this license agreement if I violate the terms and conditions of this license agreement or any rules, regulations and policies in the Community Living Guide, any municipal, state, or federal laws, or the Student Code of Conduct or fails to pay any Agreement fees. I will be given written notice of the termination and a specific date by which to vacate campus housing. If my license agreement is terminated pursuant to this paragraph, I will not be entitled to a refund and I am responsible for payment for the entire academic year. Charges for the remainder of the license agreement will be applied to my student account at the time of termination.