Housing Release Form

Submission Date: 11-21-09

Please complete and submit this on-line form for review if you are requesting to reside off-campus. Your application will be evaluated and you will receive written notification of your release status. Please note, those who fail to meet University criteria for residing off-campus will be assigned to the University room and board plan, and billed accordingly, whether or not they select to physically reside or eat on campus.

Deadlines

Fall Releases - Completed on-line forms must be submitted on or before June 15 of the Fall Semester you are applying for.

Spring Releases - Completed on-line forms must be submitted on or before November 15 of the semester prior to which you are applying for. **

**Note to resident students applying for Spring 2010** A Housing Release will only be considered for those students who have documented extenuating circumstances which demonstrate a possible risk or hardship if the student is required to live on campus. Please contact the Office of Residence Life and Housing for documentation guidelines.

Please complete the information below. Any supporting documentation should be typed and emailed to residencelife@capital.edu or mailed to our office. Please use the following documentation guidelines.

First Name:		Last Name:
Student ID Number:		CU Box Number:
Cell Number:		Email Address:


Permanent Address:
Permanent City:	Perm State:	Perm ZIP:

Current Residence Hall

Building:

Room Number:

Current Class Status:

If approved to live off campus you will need to provide your off-campus contact information where you will be residing during the academic year. This information is required for emergency contact and general University communications.

Off Campus Address:
Off Camp. City:	Off Camp. St:	Off Camp. ZIP:

Off-Campus Housing Eligibility Requirements - Please select one or more of the requirements below. Your selections will be used as the basis for evaluating your request. (Check all boxes that apply)

	Age 22 or above
	Completed 60 credit hours by the start of next semester (This information will be verified by the Office of the Registrar)
	Married (You are required to submit a copy of your marriage certificate.)
	Live with parents/court appointed guardians in permanent residency within 60 miles of the campus (This information will be verified with the Office of Admission and the Office of the Registrar.)
	Written recommendation and verification of health related issue by the family physician and verification by Student Health Services (Supporting explanation and documentation required. Please use the following documentation guidelines.
	Significant change in financial status with official supporting documentation (This information will be verified with Office of Financial Aid.) Supporting explanation and documentation required. Please use the following documentation guidelines.
	Other Extenuating Circumstances (Supporting explanation and documentation required. Please use the following documentation guidelines.

I attest that the information provided is accurate. I understand that it is a violation of the Student Code of Conduct to submit false or materially misleading information to Capital University personnel.

Agree