Keene State College | Residential Life

RESIDENTIAL LIFE

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Off Campus Housing

Request For Release from Housing/Dining Contract

By completing the form below you can request to be released from your housing and dining contract. Your request will only be accepted if you have a valid reason (see below) for needing to be released from the contract.

If you have any questions, please contact our Housing Coordinator at 603-358-2339.

All fields marked with an * are required.

Student Information

First Name*

Middle Name

Last Name*

Student ID Number*

(e.g. 0023456)

Current Information

KSC E-mail Address*
Your "@ksc.mailcruiser.com" address

Current Phone Number*
Format: 603-555-1212

Current Hall/Room Number*

Current KSC Mail Stop*

Forwarding Information

Forwarding E-mail Address

Street Address*

City*

State/Province*

ZIP/Postal Code*
If unknown or not applicable enter: NA

Country*

Reason for Request

I request to be released from my housing and dining contract for the following reason *
(Your request will be automatically granted only if you meet one of the first seven conditions below)
Withdrawal from Keene State College
Transfer to another college or university
Graduation
Student Teaching/Internship beyond a 30 mile commute
Studying Abroad**
Leave of Absence**
Marriage

(Your request will be individually evaluated if you select the following reason)
Other
Please explain if you selected "Other":

Future Campus Housing

Complete this section only if you selected "Leave of Absence" or Studying Abroad" above**
I will not need campus housing in the future.
I will need campus housing when I return in Spring 2013. I will need campus housing when I return in Fall 2013.
I will need campus housing when I return in Spring 2014.

Room Selection –if you need campus housing when you return Residential Life will select a room for you
– or –
you can designate a Keene State student to select a
room for you by entering their full name below

Agreement

By submitting this online request for release, I understand that:

It will be automatically approved – providing I meet one of the first seven conditions above
It will be reviewed for approval if I selected "Other" above and entered an explanation
Unless I defer my housing deposit, should I decide to return to Keene State College and live on campus at a future date, I will have to formally reapply for housing
I agree to properly check out of my current residence hall no later than noon on the day halls close in December or within 24 hours after completing of my last exam, and that failure to check out of my room through a staff member or by using express checkout will result in forfeiture of half of my damage deposit
It is my responsibility to give my forwarding address to the Mail Room

Please Note: We may require additional information in order to process your request. If so, we will contact you via e-mail.


Updated: November 1, 2012
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