"A Culture of Caring from Pre-hire to Retire"


Temporary Housing Request Form

Complete this form and "submit" it electronically below. If you have any questions,
please contact Helen at hmcneece@higheredrelo.com or 914-980-2412.

Institution Name:
Authorizing Dept & Contact:
Contact Phone:
Employee Name:
Home phone:
Cell phone:
Family Size:
Children's Ages:
# of Days Authorized:
Employee Email:
Work Phone:
Size of Apartment:
Temp Housing Start Date:
Destination city/State:

Special Request/Comments:

If the Temporary Housing Specialist is allowed to contact the employee, and we have your department policy on file, the Dept. contact may complete only the top section (unless the request differs from the standard policy). If the TH Specialist is NOT allowed to speak with the employee, or we do not have your department policy on file, please complete all areas of this form.

Authorization Specifics
Dept contact is to complete if request differs from policy grid.
OK to Contact Employee: Yes No
Rental Invoicing: Bill to Institution Employee Paid
Pet Deposits Paid By: Institution Employee
Maid Service Paid By: Institution Employee
Utilities Paid By: Institution Employee
Long Distance Paid By: Institution Employee

Invoicing Instructions: