Register Residence

Living Off Campus

Off campus security is a concern of everyone. To assist the Lehigh University Police Department, as well as the Bethlehem Police Department, to serve you better, please use this form to register your off campus residence when you leave on a vacation or break.

* indicates required field
	General Information
	Departure Date	*
	Return Date	*
	Total # of students in residence	*
	Residence Address	*
	Landlord	*
	Landlord Phone #	*

	Student 1
	Name	*
	Perm. Phone	*
	Perm. Address	*

	Student 2
	Name	*
	Perm. Phone	*
	Perm. Address	*

	Student 3
	Name	*
	Perm. Phone	*
	Perm. Address	*

	Student 4
	Name	*
	Perm. Phone	*
	Perm. Address	*

	Student 5
	Name	*
	Perm. Phone	*
	Perm. Address	*
	* indicates required field

(only click "Submit" button once)