Cancellation Request Housing and Food Service

Housing and Food Service Contract Cancellation Request

Office of Residence Life
Name*

First NameLast Name
Date

MonthDayYear
Date
Full Email (ex. sj189@evansville.edu)*
Campus Address (ex. Schroeder Hall 302)*
UE ID# (ex. 0123456)*
Housing Cancellation*

I am requesting to cancel my housing contract for fall.I am requesting to cancel my housing contract for spring.I am requesting to cancel my housing contract for both fall and spring.
Meal Change Request (Note: Restrictions may apply to Meal Plan Cancellation and Change Requests.)*

Cancel my meal plan.Keep my meal plan.
Reason for Request (Note: Options marked with an * must be outside of the Evansville area)*

Attending Harlaxton CollegeStudy AbroadResiding locally with parents or legal guardians (Parent/Guardian Residency Verification for must be submitted)Full-time internship*Required clinical*Approved co-op*Student teaching*Fraternity move-overTransferring to another institutionWithdrawingMedical leaveMilitaryGraduationAll classes moved to online formatOther
Where is your internship (city, state)?*
Where is your clinical (city, state)?*
Where is your co-op (city, state)?*
Where are you student teaching (city, state)?*
If moving to a fraternity, which one?*

Sigma Alpha EpsilonLambda Chi AlphaSigma Phi Epsilon
If transferring to another institution, which one?*
Signature (write with mouse or stylus)*
Students will be contacted within one week regarding this request. All required supplemental forms must be submitted before a decision can be made.
Should be Empty:

Housing and Food Service Contract Cancellation Request