Notification of Housing Contract Cancellation
Email address *
Notification
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 (https://www.formstack.com/forms/butler-exitinterview).


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 *
Required
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.
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Any additional information to share?
(Optional)
Your answer
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