Housing Office Proxy Request

If you are enrolled for the fall and are not able to attend Room Draw, you must select someone to choose a room for you when your number is called at Room Draw. The person who selects a room for you is called a “proxy.”

This form allows you to request that the Housing Office serve as your proxy for Room Draw. It should be used only by students who are looking for a single for fall term or whose entire rooming group for fall term is not able to participate in Room Draw. In the latter situation, all members of the rooming group must submit this Proxy Request naming the other members as desired roommates.

If any of your desired roommates for fall term will be participating in Room Draw then you should designate one of your roommates as your proxy. To designate another student as your proxy you must give them a written statement with your ID number granting them permission to choose a room on your behalf (a blitz from your Blitzmail account is ideal). You must also provide them with a printout of your Priority Number Look-up from BannerStudent.

Housing Office Proxy Request Form

Personal Information

Last Name	First Name
Dartmouth ID	Class (e.g. 2008)	Gender

Blitz address (please enter full address e.g. "firstname.lastname@dartmouth.edu")

What is the best way to reach you if we have questions about your request prior to Room Draw?
Blitz Other (please specify)

Why are you unable to attend Room Draw?

Request Type

Are you filing an individual request (for a single) or a group request (with roommates)?*
Individual Group

If this is a group request*, please list the names of your desired roommates.

*You should only submit a group request if NO member of the rooming group can attend Room Draw. In order to process a group request, ALL ROOMMATES listed must also submit Housing Office Proxy Requests listing all desired roommates.

Request Details

Please list a minimum of 15 rooms (in priority order) you would like us to try to secure for you in Room Draw. You must be able to fill a room in order to select it (e.g. you must a have three people in order to select a triple room).

If we are unable to secure one of the rooms above, how should we proceed? (E.g. What is more important to you: cluster/building, room type, or room size?)

Request Conditions and Submission

By submitting this form I am authorizing the Housing Office to select a room for me in the Room Draw selection process. I understand that I may designate only one proxy and that I must notify the Housing Office immediately if I choose to designate someone else as my proxy. I further understand that while the Housing Office will do its best to select a room according to my preferences outlined above, the rooms/preferences I have indicated may not be available when my priority number is reached and so I may be assigned to a room not on my preference list.

After hitting the "Submit Request" button, you will receive a confirmation email with your proxy request information.

If you do not receive a confirmation email, we have not received your proxy request. Please contact the Housing Office immediately so we can work with you to get your request submitted.

Last Updated: 11/5/08