EmailMe Form - Online Housing & Dining Appeal Form

Name *

First Last

Rice ID # *

Email *

Phone *

### - ### - ####

College Affiliation *

Status *

Date *

MM / DD / YYYY

Room # (If Applicable)

Organization (If Applicable)

Are you a student registered with the Student Disability Services? *

Yes

No

Does this appeal relate to a disability? *

Yes

No

What are you appealing? *

*Please be specific and reference a specific work order if applicable.

Detailed description *

*Please explain in detail your reason for appealing.

Submit letter or document (optional)