Intent to Vacate Form
Note:This form must be completed by all students who plan to vacate University housing (for whatever reason) before the end of the semester, at the end of the semester, or end of the academic year. Before vacating please read your Housing Terms of Agreement.
Date
MM
/
DD
/
YYYY
Banner ID (A number):
Your answer
Last name:
Your answer
First Name:
Your answer
Phone Number
Your answer
Residence Hall:
Room number
Your answer
Do you currently live in the Residence Hall specified above?
Off Campus Address:
Your answer
Reason For Vacating Campus Housing (pick one)
Semester Vacated
By placing your signature below you are agreeing to the following statement: I, the undersigned, fully understand that I will forfeit/be charged housing fees for the current academic year as stated in the contract for student housing. (Place initials below)
Your answer
Residence Hall Director (Pick one) Approval required by Hall Director
I am requesting the $250.00 Housing Security Deposit that I have paid because I will no longer reside in university housing. (If there is a balance on your account,the deposit will be applied to the current balance.)
Submit
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