Housing Cancellation Form

* denotes a required field.

Date of request:
*Student ID #:
*Student Last Name:	*First Name:	MI:
Email Address:
Phone Number:
Housing Assignment :
*Hall/Apt.:	*Room #:
*Check-out Date: Leaving: During the Semester End of Fall End of J-term End of Spring
*Reason(s) for Cancellation - mark all that apply: Transfer Commuting Moving off-campus Leaving the college Graduating Philly Study Abroad Financial Internship Marriage Medical Other (please explain)
I understand that: I cannot be officially withdrawn from campus housing until I completely vacate my room, turn in my room/apartment key, and complete all check-out procedures. Failure to complete the check-out process may result in improper check-out charges. I understand that a final inspection of my orom/apartment will be conducted by my Residence Director and any damages found may result in damage charges. I am responsible for the terms and conditions of my housing contrct and any penalties Failure to satisfay the financial obligations accrued under my contract will result in the denial of college services.
Electronic Signature My electronic signature is indicated by (1) checking this box and (2) typing my full name below. My typed full name:

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