Off-Campus Permission Application

Name: Male
(first) (last) Female
Student ID Number:
E-mail Address:
Present College Address: Present Phone Number:
Request for 2015-2016 term(s):
Number of Credit Hours
earned by January 31, 2015:

Rationale for request to live off campus, not residing with parents:

Additional information:

Please be aware that living off campus does affect some financial aid packages. Please check with the Financial Aid Office to see if this status will affect your package.

By submitting this form electronically, I authorize the Housing Office and the Housing Appeals Committee to review my academic, campus disciplinary, and financial aid records and to contact my parents during the review process. Submitting this form also verifies that all the information given concerning this application is true and accurate. Furthermore, if granted permission, I agree to respect the rights of all residents of my neighborhood. I understand that approval, if granted, is conditional based upon my efforts to be a positive resident within my neighborhood. I understand that off-campus permission is granted for the entire academic year, and not by semester.

In the event that notification is made while school is not in session, please mail notification to the following address:
(street address)
(city)(state & zip)(area code & phone number)

Application must be submitted by January 17, 2015