Your completion of this form means that you understand that you must officially checkout of the residence hall to avoid being billed for housing and to avoid being fined for improper checkout. This means that you must make an appointment to return your keys to a Residence Life staff member and have all of your belongings removed from the room at that time. In addition, please note that your belongings must be removed from your room and you must turn in your key within 48 hours from the effective date below.

First and Last Name

Student ID No.

Current Room Assignment (Residence Hall & Room No.)

Date you will be vacating the residence hall (effective date)

Please check your intention:
To move off campus
To transfer to another college/university
To take some time off from college

Please check the reason(s) which best describe why you are leaving:
Financial
Privacy
Inability to Study
Other