Department of Residence Life

Official Use Only

Date Received: ______________

Approved:  □Yes  □No

Reply Sent:   □Yes  □No
_____________________
Director of Residence Life Signature

Housing Cancellation Request Form

Please read and fill in the boxes of the Housing Cancellation Request Form if you would like to decline or terminate your housing contract or assignment. Print and sign the document to confirm you have read and understand the conditions of this form. For more information, please refer to the back page of the Housing Contract or the Guide to Residential Living.

 

First Name
Middle Initial
Last Name
Gender
Banner ID# (Required)
Classification
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Contact Number i.e. XXX-XX-XXXX
E-mail
Semester You Request To Cancel
Current Building Assignment
Intended Contract Release Date (Check-Out if applicable) i.e. MM/DD/YYYY
Reason for Cancellation
The two signatures below are required on this form before it can be submitted.
____________________________ Signature of Applicant/Requestor		_____________________ Date
____________________________ Signature of Residence Hall Director		_____________________ Date
All cancellation requests are not automatically approved.   All Housing Cancellation Request  Forms should be mailed or faxed to the main office of Residence Life AFTER the requestor and their Residence Hall Director have signed this form.  You should receive a response from the Residence Life Office regarding your status within three days of submission;  If not feel free to call 1-888-539-1616 (toll free) or locally (910) 672-1284 to inquire.   *** It is important to note that IF your request is approved it may take approximately two weeks for your student account to be adjusted. Main Office Fax#: (910) 672-1286