Imagery of Regent people and campus

Request to Terminate Student Housing Agreement

ATTENTION: Please be aware, any and all residents who choose to terminate their Student Housing Agreement before their original set end date for any reason other than complete withdrawal from the University, will automatically forfeit their housing deposit on file, and remain financially responsible for the original housing agreement fee, for the remainder of their originally set Housing Agreement term.

Date of Request:
Name of Resident:
Housing Assignment (Building/Room #):
Phone Number (day):
Phone Number (eve):
Reason for Request to Terminate Student Housing Agreement: Medical
Please Explain Your Reason:
For All Residents Submiting
Please acknowledge the following: I affirm that the information provided above and all supplemental documentation are true and honest statements. Further, I understand that action may be brought against me by the university under the Student Handbook for providing false or misleading information, statements and/or records.