Occupancy Agreement Release & Request For Occupancy Agreement Release (Page 2 of 2) in pdf

Occupancy Agreement Release & Request For Occupancy Agreement Release Page 2

Drew University Housing Office

36 Madison Avenue

Madison, New Jersey 07940

973.408.3037

REQUEST FOR OCCUPANCY AGREEMENT RELEASE

Please read the attached Housing Occupancy Agreement Release Procedure before completing this form.

Student’s Name:

Campus Address (Hall and Room):

Campus Mailbox:

Telephone:

e-mail:

I. Date requesting to vacate:

II. Reason for requesting a release from my Housing Occupancy Agreement is:

_____ Medical

_____ Financial

_____ Other

Please enclose or attach a written statement describing the reasons for your request.

III. Documentation to support request:

MEDICAL:

_____ Drew Health Services Director’s statement (required)

_____ Personal Physician’s statement (optional)

FINANCIAL:

_____ Financial Aid information

_____ Verification of financial problems

_____ Completed budget

All circumstances described in this release request are true to the best of my knowledge and no

documentation has been falsified or misrepresented.

Student’s signature:

Date:

Occupancy Agreement Release & Request For Occupancy Agreement Release Page 2