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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 start and 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 a prorated amount of the original semester fee dependent upon when the resident terminates their Student Housing Agreement. Residents can find the associated fees in the Student Housing Agreement (Section 4, Letter M).

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. I also affirm that I have read and understand the fees associated with terminating my Student Housing Agreement. 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.