Part 1, Your Information

First Name:

Last Name:

UM Uniqname:

Your UM-email address *
* required for form to work properly

UMID :
(enter as 0000-0000)

Today's Date :

Part 3 Payment and Agreement

• University Housing will charge to your student account the rental fee. The total payment is due when invoiced by University Student Financial Operations.

By submitting this online application I agree to the terms on Air Conditioner Request/Rental for Residence Hall Room and I agree to pay the amount billed to my student account.  I also realize that the  application is not complete until University Housing receives medical documentation that establishes my need for an air conditioner, utilizing the form at http://www.housing.umich.edu/pdfs/disabilitiesform.pdf.

(Please press submit once and wait for a confirmation screen. It is normal for the system to take up to one minute to process your application)