Move-out Extension Application April 2015 Note: Extensions will not be granted to accommodate lease or sublet agreements, employment or storage needs. Please submit this form to the Housing and Conference Service Centre (in Mary Keyes or Commons Lobby) by 12 Noon on Wednesday, April 1st, 2015. Late applications will be fined $50 or may not be considered. First Name (please print) Residence Building Last Name (please print) Room # Bed Space Student ID # A response to your extension request will be sent to your McMaster email after the deadline date. Original Move Out Date Please complete and sign the appropriate section: Section 1: International/Out of Province Students with Travel Requirements (Copy of flight itinerary is required) Section 2a & 2b: Academic Requirement Section 1: International/Out-Of-Province Students - Travel Requirement Please sign below and attach a copy of your flight itinerary (i.e. E-Ticket). Copy of Flight Itinerary/E-ticket Attached I understand, if granted an extension, I must continue to abide by the Residence Agreement/Contract and the Residence Code of Conduct. Current Date Student Signature Section 2a: Academic Requirement: This section is to be completed and signed by the student. Course Name & Code (i.e. Psych 1G03) Reason for Move out Extension (Please choose one) Date of Academic Requirement/Exam New Exam Course Code Lab/Thesis/Inquiry (dd/MM/yy) Other: I understand, if granted an extension, I must continue to abide by the Residence Agreement/Contract and the Residence Code of Conduct. Student Signature Current Date Section 2b: This section MUST be completed and signed by your Professor to verify your academic requirement. Professor's Name (please print) First Name Date of Academic Requirement/Exam McMaster Extension Ext. Last Name (dd/MM/yy) I hereby verify the student identified on this form must meet the new academic requirement and/or exam. Professor's Signature Date of Signature The information gathered on this form is collected under the authority of The McMaster University Act, 1976. This information will be used only for the purpose of providing appropriate accommodations where possible. This information is protected and being collected under Section 39(2) and Section 42 of the Freedom of Information and Protection of Privacy Act of Ontario (RSO 1990). For complete details of McMaster's Policy on the Collection of Personal Information please visit "http://www.mcmaster.ca/univsec/fippa.cfm" Print Form Office Use Only Date Received ____________________ Emailed Approved Move-Out Date ______________________ Date Emailed: ___________________ Staff Initials: ______ Late Application Fee Applies