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Room and Board Contract

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					                                          SUMMER 2011 HONORS ACADEMY HOUSING AND DINING CONTRACT
                                        Contracts are processed by date received. Payment must be received by
                                               May 27, 2011, to secure your space in the Residence Hall.


          STUDENT INFORMATION

NAME:                                                                                               DATE OF BIRTH:

HOME ADDRESS:                                                                                       GENDER:

CITY, STATE, ZIP:                                                                         EMAIL:


STUDENT SIGNATURE:                                                                                                       DATE:


PARENT OR GUARDIAN SIGNATURE:                                                                                            DATE:


ROOM AND BOARD PREFERENCES

I WILL (Please check one):              LIVE ON CAMPUS ⃞                        COMMUTE FROM HOME ⃞

OPTIONS (Please check all that apply, and write in amounts):

          Housing & Dining fee (five weeks, double room; 14 meals per week): $1,640.00

          Optional Linen Service (bed made prior to arrival; weekly linen change; bi-weekly towel change) $175.00

          Meal Plan Only (for commuters; 14 meals per week): $ 756.00

          Total Due by April 29 (please make checks payable to Ohio University)


CREDIT CARD PAYMENT

          MasterCard ⃞                  VISA ⃞              Discover ⃞             American Express ⃞

CARD NUMBER                                                                                                       EXPIRATION DATE

SIGNATURE                                                                                                         DATE

This section of your contract is a requirement of Ohio Revised Code Section 3345.85 regarding the meningococcal meningitis and hepatitis B vaccination status of
students living in on-campus student housing. By signing this section of the contract, you agree to have read and understood the enclosed vaccination documents
and/or visited the web site at http://www.cdc.gov and that the following information is true to the best of your knowledge.

Meningococcal Meningitis Status                                       Hepatitis B Status
I have been vaccinated against Meningococcal Meningitis.              I have been vaccinated in whole or in part against Hepatitis B.

No   ⃞ Yes ⃞                                                          No   ⃞    Yes   ⃞ Vaccination Dose 1 Date
                    Year received                                               Yes   ⃞ Vaccination Dose 2 Date
                                                                                Yes   ⃞ Vaccination Dose 3 Date


Student Signature                                                               Parent/Guardian Signature (if student is under 18 years of age)

REFUND POLICY AND SCHEDULE
Refunds are made only for students who do not attend or who withdraw from Ohio University. Notice of cancellation must be received by letter, fax, or email on
the following schedule:
           Prior to Summer Session opening: 100%     Through 1st week: 60%     Through 2nd week: 40%        Through 3rd week: No refund
                     Return completed contract and payment to:
Office of Summer Sessions/Honors, Haning Hall 205, Ohio University, Athens OH 45701
            Fax: 740-593-2901          Email: summer.sessions@ohio.edu

				
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