Rutgers Newark Office Of Housing-Residence Life Vacate Request Form
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RUTGERS-NEWARK OFFICE OF HOUSING & RESIDENCE LIFE
INTENT TO VACATE REQUEST FOR SPRING 2016
All requests, along with any supporting documentation, must be submitted to the Office
th
of Housing & Residence Life in Woodward Hall by Monday, November 30
, 2015.
Contact the office at (973) 353-1037 or email
aei3@andromeda.rutgers.edu
with
questions.
Name: ______________________________
RUID: ________________________
Class Status: ___FR ___SO___JR____SR ___Graduate Student
Hall: ___Talbott ___Woodward ___University Square ____15 Washington
Room: _______________
Contact Phone: (_____)________________ Email Address: ____________________
Home Address:_________________________________________________________
______________________________________________________________________
REASON FOR YOUR RELEASE REQUEST:
1. ___ Graduation. (All classes are complete.)
2. ___ Withdrawal, study abroad, or transfer from Rutgers. (Transfer/study abroad
please attach a copy of your acceptance letter.)
3. ___ Marriage, pregnancy or recent birth. (Attach supporting documentation.)
4. ___ Loss of University financial aid. (Attach supporting documentation.)
(If you need additional space for comments please attach another sheet.)
Once reasons 1-4 are verified, Residence Life will automatically release you from your
housing contract. If you are being charged the $500 cancellation fee it will be placed on
your university account.
Note: If our office finds out that you have falsified your academic records in an effort to
leave housing, you will be charged the remainder of the 2015-2016 Housing Contract.
What day will you vacate your room? ___________________________________
You will need to vacate your room by no later than December 22, 2015 at 12Noon, the
last day of the fall semester. You must check out formally with a RA by turning in your
keys and having your apartment inspected.
Signature: _____________________________________ Date: ___________________
For Office Use Only
___OD __PR
___$500 Fee
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