ACKNOWLEDGEMENT OF STUDENT. THIS IS A LEGALLY BINDING AGREEMENT. IT IS UNDERSTOOD AND AGREED THAT YOU ACCEPT AND AGREE TO THE TERMS AND CONDITIONS OF THIS CAMPUS HOUSING AGREEMENT, ALL REQUIREMENTS AND RULES OF THE CORPORATION, AND ALSO THAT YOU ARE RESPONSIBLE FOR ADHERENCE TO ALL OTHER POLICIES SPECIFIED IN THE BLUEFIELD STATE COLLEGE RESIDENCE LIFE MANUAL AND BLUEFIELD STATE COLLEGE STUDENT HANDBOOK. YOUR SIGNATURE ACKNOWLEDGES YOUR AGREEMENT AND INDICATES THAT YOU HAVE REVIEWED THE ON-LINE STUDENT HANDBOOK AND ON-LINE RESIDENCE LIFE MANUAL. IT IS ALSO UNDERSTOOD THAT INFORMATION REGARDING POLICY VIOLATIONS CAN BE SHARED WITH YOUR PARENT AND/OR GUARDIAN. YOU ACKNOWLEDGE AND AGREE THAT YOUR FAILURE TO COMPLY WITH THE TERMS OF THIS CAMPUS HOUSING AGREEMENT MAY SUBJECT YOU TO DISCIPLINARY ACTION ACCORDING TO THE RULES AND REGULATIONS OF THE COLLEGE, AS WELL AS REMEDIES OF THE COLLEGE AND CORPORATION REFERENCED HEREIN. BLUEFIELD STATE COLLEGE AND THE CORPORATION MAY REMOVE YOU FROM THE ASSIGNED RESIDENCE HALL SPACE IF, IN THE JUDGMENT OF THE COLLEGE OR CORPORATION, YOU HAVE ENGAGED IN OR THREATENED ACTS OF MISCONDUCT SUCH THAT YOUR CONTINUED PRESENCE IN ON CAMPUS RESIDENCY MAY ENDANGER PUBLIC ORDER, PROPERTY, THREATEN THE PERSONAL SAFETY OR SECURITY OF OTHERS (WHETHER BY ACTS OF PHYSICAL OR VERBAL HARASSMENT OR VIOLENCE OR OTHER MEANS) OR BE SUFFICIENTLY DISRUPTIVE AS TO ADVERSELY AFFECT THE ABILITY OF OTHERS TO PURSUE THEIR EDUCATIONAL GOALS. Last Name First Name Middle Initial Student ID Number Street Address Email Address City, State, Zip Date of Birth (mm/dd/yyyy) Xxxx of Students (signature) Date Student Resident (signature) Date Parent/Guardian (if Student Resident is under 18) (signature) Date
ACKNOWLEDGEMENT OF STUDENT. DEPARTMENT | COURSE | SECTION # STUDENT’S SIGNATURE STUDENT’S NAME DATE SIGNED ACKNOWLEDGEMENT OF PROFESSOR INSTRUCTOR’S SIGNATURE INSTRUCTOR’S NAME DATE SIGNED REQUEST TO RETAIN RECORDINGS AFTER CONCLUSION OF THE COURSE I request to retain the audio recordings under the following conditions, and for the following reason(s):
