MIT Undergraduate Housing

Housing Smoking Agreement Form The MIT Policy on Smoking for Undergraduate Housing states: Smoking Smoking is prohibited in all areas of MIT residence halls, including all student rooms, hallways and lounges, except as noted below. Certain designated MIT residence halls allow smoking in private residences (e.g., Housemasters' apartments) and in student rooms if all of the students are smokers and request in writing that smoking be permitted in their rooms. Anyone who violates this policy will be subject to discipline under the procedures applicable to him or her as a student at MIT. In rooms, where each resident has agreed that smoking be permitted, a smoking agreement form must be filled out by each individual in that room . Roommates who cannot come to agreement, and who have not all filled out an individual smoking for, are prohibited from smoking in their individual room. Please note: Only those student living in Bexley, East Campus, MacGregor, Random, and Senior House are able to smoke in individual rooms in areas of the building where smoking is permitted, and agreement is made via the form below. Students living in Baker, Burton Conner, McCormick, New House, Next House, and Simmons Hall, and all Graduate Halls are prohibited from smoking in any area of these buildings. Contact Undergraduate Housing (email: residence@mit.edu) at 617-253-2811. Updated: November 30, 2007 Housing Smoking Agreement Form: (Each roommate must submit an individual form) Information about person completing this form (required): Roommate #1 (person completing this form) Last: First: Email: MIT ID #(person completing this form) Building Baker House Bexley Hall Burton Conner East Campus Macgregor McCormick New House -Choc. City -French Hse -German Hse -Spanish Hse Next House Random Hall Senior House Simmons Hall Room Number Number of Roommates 0 1 2 3 4 Information about roommates Roommate #2 Last: First: Email: Roommate #3 Last: First: Email: Roommate #4 Last: First: Email: Roommate #5 Last: First: Email: Please review this form for correctness, then when finished. A copy of this agreement will be sent to your e-mail address. Or, click this button to erase your entries and start over.

Smoking Agreement now available on-line