Contract Form

* Indicates required field.

Student Information


Parent/Guardian Information

Note: Parent/Guardian listed will be emailed a copy of this contract to be notarized.

Room Assignment Survey

I wish to share an apartment with (list the names of up to four students you would like to request):
Requests will be honored only if all students involved in the request have turned in applications and are not on a waiting list at the time assignments are made and have all requested each other. Assignments are made based on date received.
Please number all of the following apartment styles 1 through 6 with 1 being first preference and 6 being last *
Please only use each number once
Reservoir Run
4–Person Suite Style Apartment (4 Single Bedrooms)
Campus Meadows
Townhouse (two double bedrooms)
Two bedroom Flat (one double and one triple bedroom)
Five Person Flat (one bedroom w/ five students)
College Hill
Single in Two Bedroom Shared Apartment (one single bedroom and one double bedroom)
Double in Two Bedroom Shared Apartment (one single bedroom and one double bedroom)
All housing is smoke-free. This question relates to your sensitivity to the smell of smoke.
If interested, please contact the Residential Life and Housing Office

Meal Plan *

Herkimer College Alerts

Due to the winter storm, Herkimer College will be closed on Sunday, January 20th. The College will also be closed Monday, January 21st in observance of Martin Luther King Jr. Day. This includes the Fitness Center both days.

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