University Residency Requirement Exemption Request Page 3
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1
2
3Attach to the University Residency
Requirement Exemption Request
Form & Return to:
The Office of Residential Living
WTAMU Box 60878
Canyon, Texas 79016
WTAMU Residential Living
t 806 651 3000 f 806 651 3010
LIVING/MEALS WITH PARENTS
housing@wtamu.edu
Notary Form
This notarized statement for the Living with Parents or Meals with Parents exemption types should be
attached to the official exemption request form, available at: wtamu.edu/residentialliving.
These
exemption types are only valid for one (1) Academic Year (fall/spring); the student must re-apply prior
to the deadline each fall semester (August 1) if still under the University housing/meal requirement.
Please Print or Type:
Semester / Year that I am applying for:
Fall 20_____ / Spring 20_____
Request
:
Living w/ Parents
Meals w/ Parents
(check one)
NOTE:
WTAMU’s Housing Agreement is valid for one full academic year; a student who is currently under a housing agreement,
and submits a residency exemption request after the official move-in day of the Fall semester, will be denied.
Student Name:
Buff ID:
Name of Parent:
Parent Phone:
Parent Physical Address:
Apt.:
City:
State:
Zip: ____
___
I understand that this is a sworn statement to the State of Texas and affirm that all the information herein and attached
is correct and factual to the best of my knowledge. I also understand that if this exemption request is not granted or is
revoked, I will be responsible for charges to my University account for a room and/or meals. I further
understand that the University may conduct periodic checks to verify student residences throughout the year.
The above-named student will be living/
I will be living/eating with the parent/
eating with me, the parent/legal guardian,
legal guardian listed above at the
at my permanent legal address listed.
permanent legal address listed.
Parent’s Signature
Student’s Signature
Date
Date
Subscribed and sworn before me at:
Subscribed and sworn before me at:
City and State
City and State
Signature of Notary Public
Signature of Notary Public
Date Commission Expires
Date Commission Expires
NOTARY SEAL
NOTARY SEAL
With few exceptions, state law gives you the right to request, receive, review and correct information about yourself collected from this form.
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