Release/appeal Form
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1RELEASE/APPEAL FORM
Name (print): _____________________________
Stud ID: ____________
Campus Phone: _________________________
Current E-mail: _________________
___________________
Cell/Home Phone Number: ________________
Current Housing Assigned Building: _______________
Room ___________
Class Year: _____________________________
Home Street Address _____________________________________ Home City/State/Zip _____________________________________
Release/Appeal For:
Contract Release Request For:
Administrative Billing Appeal For:
Appealing:
Housing
Damage (room/community)
Full Time Status
Semester: ____________
Dining Services
Requested Housing (intersession)
Housing & Dining Services
Improper Check-Out
Year:
____________
Key/Lock Replacement (room/mailbox)
CONTRACT RELEASE REQUESTS:
1.
will be reviewed by the Director of Housing or the Director of Campus Services and decided on a case by case
basis
2.
must be accompanied by the student’s general summary of reasons for requesting contract release
3.
must include documentation supporting the reason for this request as listed below:
Letter from a physician explaining in detail a student’s inability to live in on-campus housing and a
completed Medical Release Form
Document confirming an unanticipated financial need or hardship and the completion of a Financial
Release Form.
Document from the Registrar stating that the student is enrolled in less than 12 credits
A copy of military orders which includes the date a student is required to report for active duty
ADMINISTRATIVE BILLING APPEALS:
1.
will be reviewed by a committee appointed by the Housing Director and decided on a case by case basis
2.
must be accompanied by documentation supporting the appeal. Documentation examples:
Housing building & room assignment that is relevant to the appeal
Description of the specific amount being billed
Reason(s) why the amount should be reduced or removed from the student's bill. Examples of
legitimate reasons: another person taking responsibility for the damage, pre-existing damage,
damage caused by normal wear and tear
FULL-TIME STATUS APPEALS
1.
will be reviewed by the Director of Housing (or designee) and decided on a case by case basis
2.
must be accompanied by documentation supporting the appeal. Documentation examples:
A letter from a faculty member or other University Official explaining your need to remain on campus to
further your academic pursuits (i.e. undergraduate research, thesis, internship, etc.)
A copy of your current student record documenting current status and indicating potential need or
reason to be enrolled for less than full-time status
If Graduate Student, a copy of a completed “Enrollment Status Form”
I hereby state that the information I have provided in this form is accurate and honest to the best of my knowledge.
Student Signature______________________________________________________________
Date:____________________________________________
Administrative Use Only
Appeal Review Decision:
Approve _______
Deny ________
Date: ___________________
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Parent category: Legal