Room Change Request Form

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Office of Residence & Commuter Life
Room Change Request Form
Only students with a housing assignment are eligible to complete this application. Please print legibly.
FULL NAME _________________________________________________________ ID NUMBER __________________
CURRENT SEM. LEVEL _______________________ NDMU E-MAIL ___________________________________________________
CURRENT BUILDING / ROOM __________________________________ PHONE NUMBER ___________________________
Have you been approved for housing accommodations through Disability Support Serves?
YES
NO
Requesting room change beginning (check one):
current semester
future semester (sem/year) ________________________
Reason for Request
All room change requests for the current semester must be signed by the Graduate Residence Coordinator (GRC) for
your current residential area following a meeting with the GRC to discuss your reasons for seeking a change.
Completed forms will then be turned in to the Assistant Director for Residence & Commuter Life.
IMPORTANT: Completing this form and turning it in does not automatically guarantee a room change will occur. Attempted
mediations to resolve roommate conflicts are first expected before proceeding with the room change request unless it is during Open
Room Change. All room change requests require consent from the Assistant Director of Residence & Commuter Life. Room changes will
only be granted pending their approval. All room changes are subject to room availability. If approved, you will receive an e-mail with
instructions for moving.
Student Signature: ________________________________________________________________ Date: _____________________
Graduate Residence Coordinator Observations/Comments
GRC Signature: ____________________________________________ Date: _____________________
Comments
Residence Life Office Use Only
Assistant Director
Date Rec’d ________ Date Approved: ________
______________________________________________________________
Denied – Reason _________________________
Resident Confirmation e-mail: ______________
GRC Confirmation e-mail: __________________
______________________________________________________________
Bus. Office/Fin. Aid e-mail: _________________
Roster/Datatel updated?:___________________

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