Notification of Housing Contract Cancellation
Email address *
If living on campus you must fill out this form. If you've contracted for housing for the upcoming academic semester you must cancel by December 1st for a refund of the housing deposit. If you've contracted for the next academic year, you must cancel before June 1st for a refund of the housing deposit. If you are submitting this form after December 1st for a move-out during/at end of the fall semester, there will be a $100 cancellation fee charged to your student account.

If you are transferring or withdrawing from Butler and not intending to return, please set up a short exit interview with the Center for Academic Success & Exploration (317-940-9308) or the Office of the Dean of Students (317-940-9470), or complete the online exit interview survey (

First Name *
Your answer
Last Name *
Your answer
Butler Student ID Number *
Nine digits only, starting with 400. Note the number listed at the bottom of a Butler ID card has 11 digits, and the last two digits should not be entered.
Your answer
Butler email address *
Your answer
I hereby notify Butler Residence Life that I will be vacating my on-campus housing assignment for the reason indicated: *
Please note, only those pre-approved to do so may give "Other" as their reason.
When do you intend to return to living on campus? *
This is a non-binding choice, and you must contact Residence Life if you wish to return. There is no guarantee of a specific housing assignment. Additional action will be required in order to receive a housing assignment for your return.
Time frame for leaving *
Read all the statements below and check the boxes to indicate understanding *
Current Housing Assignment *
Current Apartment or Suite and/or Room *
Your answer
Current Meal Plan *
Date of intended check-out *
Please note, if you are unsure about an exact date for an end of fall semester leave, select the last day of finals week.
Any additional information to share?
Your answer
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