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Room Change Request

Resident Information:
Name:
Email Address:
Building #:
Room/Apartment #:
Phone:
Housing Assignment Desired:
Regent Village
Phase I - Upstairs
Phase I - Downstairs
Phase II - Upstairs
Phase II - Downstairs
Constitution Hall
Shared Studio
Shared One Bedroom
Four Bedroom Suite
Foundation Hall
Shared Studio
Shared One Bedroom
Four Bedroom Suite
Reason for room change:
Room Change
Date Requested:

All room changes are subject to a $250 Fee

Please list your current roommate(s):

Signature:
Date:

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