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Residence Life at Messiah College

Housing Cancellation Request

 

*all fields are required

Today's Date Student ID#
Last Name First Name MI
Residence Hall/Apartment Building Room Number
Please check the appropriate category:
Leaving: During the Semester: Check-out Date:
End of Fall:
End of J-term:
End of Spring (only complete after Spring Housing selection)
Reason(s) for Cancellation (mark one from each section if applicable)
Section A Section B Section C
Transfer Academic Dismissal Internship
Commuting Disciplinary Marriage
Moving Off Campus Financial Medical
Leaving the College Noise
Graduating Roommate Conflict
Philly
Study Abroad: please tell us where you're going
Other:

I understand that:

  • I cannot be officially withdrawn from the residence halls until I completely vacate my room, turn in my room/apartment key, and complete all check-out procedures.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 room/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 contract and any penalties.
  • Failure to satisfy 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, (2) typing my name in the corresponding box, and (3) entering my Messiah College e-mail address in the corresponding box.
Student Signature E-mail



If you would like to print out a PDF version of this form, please click the link below:

 Housing Cancellation Form

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