Cancellation Request Housing and Food Service

Housing and Food Service Contract Cancellation Request

Office of Residence Life
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Email (ex. sj189@evansville.edu)
Campus Address (ex. Schroeder Hall 302)
UE ID# (ex. 0123456)
Housing Cancellation
Meal Change Request (Note: Restrictions may apply to Meal Plan Cancellation and Change Requests.)
Reason for Request (Note: Options marked with an * must be outside of the Evansville area)

Other
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?
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