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Office of Residential Programs Special Interest Community Alternate List Confirmation

You have been placed on the alternate list for the Special Interest Housing Community. Please confirm whether you would like to remain or be removed from the alternate list for the 2015-2016 academic year. If you have any questions please contact Nathan Johnson, the Associate Director for Special Interest Communities and Faculty Initiatives at npj2110@columbia.edu.

First Name *

Last Name *

UNI *

Mobile Phone Number (xxx-xxx-xxxx) *

Would You Be Interested in Other Special Interest Communities Outside of Your Initial Preference? *

Yes

New radios *

I would like to remain on the Special Interest Community Alternate List for the 2015-2016 academic year.

I would no longer like to be considered for a placement in the Special Interest Community for the 2015-2016 academic year.

New date

Year

Month

Day

Electronic Signature (by typing your name you confirm your decision noted above) *

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Office of Residential Programs Special Interest Community Alternate List Confirmation

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