Milton Hershey School
Application for Housing/ Residence Agreement
Updated 4/2013
I hereby apply, subject to the terms of this application and agreement, for a residence room at Milton Hershey School (MHS) from
(arrival date) _________________ through ___________________ (departure date).
I am requesting housing due to:
____Summer housing/working on campus
___College Break
___Emergency (please attach a summary outlining the circumstances of your emergency)
I understand that MHS to withhold monies from my CES should I or one of my guests, misuse or damage MHS property or do not adhere
to the guidelines and policies as outlined on the attached form.
[ ] I authorize verbal exchange with Milton Hershey School staff regarding my personal information.
Please Print: Name_________________________________________________________________________________
LAST
[ ] Male [ ] Female
FIRST
Date of Birth ___________________________
MONTH/DAY/YEAR
MI
Year of Graduation: _____________
Drivers License ID # _______________________________ State: ____________
Home Address____________________________________________________________________________________________
STREET CITY STATE ZIP
Home Phone # (_______) __________________ Cell Phone # (_______) ____________________
E-mail Address: _________________________________________
Currently employed No [ ] Yes [ ]
If yes, name of Employer:___________________________________________________
Phone: ____________________
Emergency Contact Information: Name:__________________________________________ Phone:____________________
Adult Employee at MHS who knows me best: ______________________________________ Phone: ____________________
Will you have a vehicle on campus? [ ] yes [ ] no If yes, you must provide proof of registration & insurance with this application.
Auto Insurance Company:_____________________________ Policy #:____________________ Phone:______________
Car Make/Model: ___________________________ Plate #________________________
My signature below acknowledges that I understand the terms of this agreement and verify that I have read the terms as outlined on
the back side of this agreement.
Alumni/Employee Signature ____________________________________________________________ Date __________________
Parent/Guardian’s Signature ____________________________________________________________ Date __________________
(Required if student is a minor under the age of 18 years.)
Terms of Agreement
License not a lease: This agreement is a license and not a lease. It creates no exclusive right on the part of the MHS Alumnus resident to occupy any
particular portion of MHS property. The School may assign and reassign the alumnus to specific housing whenever, in the School’s sole discretion; it
deems such action necessary or desirable. As a licensee hereunder the MHS alumnus resident may not assign any rights or obligations created by this
license agreement.
Eligibility: To be eligible to reside in MHS facilities, the MHS Alumnus must be under the supervision of the MHS Twelve Plus Housing Program and if
employed, pass all necessary clearances pertaining to MHS.
Term: The term of this agreement may end at any time the School identifies and residents will have up to 24 hours to vacate the premises.
Assignments: The School will attempt to honor the preferences expressed by the MHS alumnus for a room assignment and reserves the right to
(re)assign the MHS Alumnus to other rooms or facilities when necessary. Residents must remain in assigned rooms.
Facility: Each resident is responsible for their assigned room and for all common areas of the facility. Residents will maintain a clean room and
environment in the facility by sharing cleaning and upkeep responsibilities of common areas (i.e.; bathrooms, kitchen, living room, dining room,
hallways, stairwells, basement, laundry room, outside of home, etc).. In addition to cleaning and maintaining the common areas of the home, all
residents are responsible for the condition of common areas and every resident is responsible for any and all damages that cannot be attributed to a
resident or guest where damage charges can be assessed and collected. MHS Staff reserve the right to inspect/search any areas of each facility
(including apartments, common areas, sleeping rooms, etc).
Housing Fees: Fees will be determined by MHS and shared with applicants/residents prior to signing the agreement.
Personal Property: The MHS Alumnus hereby agrees that any and all of the MHS Alumnus’ personal property or property of third parties in the MHS
Alumnus’ custody or possession which may be present upon the School’s premises shall be the sole responsibility of the MHS Alumnus. The MHS
Alumnus does hereby waive any and all claims against and does hereby agree to indemnify, defend and hold harmless the Board of Directors of MHS,
its officers, agents and staff for loss, damage or destruction of any cause whatsoever. All personal property must be removed from the MHS Alumnus’
room no later than the last day of occupancy and the MHS Alumnus hereby surrenders all claims to and abandons any property remaining on the
premises after such date. MHS reserves the right to inspect/search any areas of each facility (including apartments, common areas, sleeping rooms,
etc).
Security Deposit: A $100 security deposit ($100 refundable upon approved checkout – without damages or missing items) is required to accompany
all applications for MHS summer/break housing and will be retained by MHS for so long as the MHS Alumnus resides in any MHS residence. Unless
the deposit is forfeited under any of the terms of this agreement, the $100 deposit, less any assessment for damages, or outstanding school charges,
will be refunded to the MHS Alumnus following termination of the housing agreements by the MHS Alumnus and inspection of the premises and
property by representatives of MHS. The MHS Alumnus agrees to be responsible for any cost of defacement or damage to the room or rooms,
common areas and all MHS provided furnishings or property that are damaged or destroyed during the term hereof. Lost or stolen keys must be
reported to the MHS Home Life Office immediately upon awareness that the key is missing. Replacement keys cost $20. The security deposit will be
mailed to the resident’s permanent address listed on this application and agreement no later than 1 month following departure from MHS. If any
damages are over $100.00, the amount may be deducted from your deposit and/or CES funds and if that is not sufficient, a bill will be sent to you.
Cancellation by MHS Alumnus: The MHS Alumnus hereby consents and agrees to obey and abide by all MHS policies and regulations governing
occupants of housing facilities and recognizes the right of MHS to terminate this agreement for breach of any such School policies regulations. If the
MHS Alumnus voluntarily requests cancellation of this agreement or is removed for disciplinary reasons, the MHS Alumnus may forfeit the security
deposit.
Vacating of Premises: In the event of cancellation or termination of this agreement, the MHS Alumnus hereby agrees to vacate all MHS housing
facilities within 24 hours of notification of such cancellation or termination. The MHS Alumnus further agrees to vacate all MHS housing facilities prior
to the date and time of closing of such facilities. If MHS Alumnus is declared a No-Show, the deposit may not be refunded.
Room Entry: MHS reserves the right for authorized School representatives to enter all rooms for housekeeping purposes, inspection, search, repair or
maintenance, health, safety, or disciplinary reasons (including apartments, common areas, sleeping rooms, etc and all MHS property within).
Fraternization with MHS Students: As a condition of your residency at MHS, alumni are not permitted to socialize, or entertain MHS students at the
residence facility. The exception to this rule is visitation with siblings at their student home – siblings are not permitted to come to the summer
residence (Cloverdale, Willow Wood or Southfield).
Accountability for Guests: Please be certain you are aware of the location and are paying attention to the behavior of your guests when visiting MHS.
Former students or alumni who are not permitted on the MHS campus are not permitted to visit you in your residence. You will be held responsible for
any damages or actions as a result of your guest’s behavior.
IMPORTANT GUIDELINES:
All residents are responsible for the behavior of their guests
MHS students who have not yet graduated from MHS are not permitted in alumnus housing facilities.
Alcohol, Tobacco and other illicit Drugs are not permitted on the MHS Campus
Firearms or similar items such as BB Guns or water pistols are not permitted on the MHS Campus.
No visitors are allowed in housing facilities without prior permission of the facility coordinator.
Once visitors are approved, visitation hours in each residence are: 9:00 a.m. – 11:00 p.m.
Visitors/Visitation only permitted in common areas of the facility (kitchen, living/dining rooms).
Ignorance of a policy is not a defense
All residents must abide by all MHS policies during their period of residence
MHS policies can be found at http://intranet.mhs-pa.org
Vehicles on Campus
MHS students may not ride in your personal vehicle
Your vehicle must be parked in designated parking areas – vehicles cannot be parked under service
carport immediately adjacent to the building, nor on any road or grassy/dirt area
Vehicles left by you on campus after your employment ends will be towed within 72 hours
You must display an MHS vehicle tag on your rearview mirror or front dash at all times
Vehicles not displaying a proper MHS tag or having expired tags will be towed at owner’s expense