I am requesting to be released from my housing agreement and be relieved of the financial responsibility of the residence hall fee payment, except for the nonrefundable $200 deposit fee. 
Request for  Semester of  (Academic Year),  
I am requesting to:  

Address of parent(s)/guardian(s): 

I am making this request to be released form my housing agreement for the following reason(s): (Check all that apply.)

: Financial data will be verified with the Financial Aid Office.  What has changed in your financial situation since the time you signed the housing agreement? What is the amount of projected savings?


: Include employer’s name and address below.  Explain why you are unable to reside on campus and perform employment duties.  Were you employed in this job when you signed your housing agreement?


Send requirements from physician. All medical information shared for the purpose of being released from the housing agreement needs to be processed through the Office of Disabilities Services. Explain how living on campus affects your health:


What has changed in your family or personal situation since the time you signed the housing  agreement?  How will residing at home or off-campus resolve or improve this situation?




Name of Student: First Name:    Last Name:    

Student ID: 

Hall:       Room#:       Email: