Request for Refund by dffhrtcv3

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									              Refund
Request forHousing Security Deposit
      of $125

            PRINT NAME:
            STUDENT ID#:
                   DATE:

             Current Hall:
                   Room:
              High School
          Graduation year:



            Reason for Separation
             (Complete Section A, B OR C, sign and date below)

             A                                    I am graduating. Year:


             B                                    I will no longer be attending UW-Whitewater after current housing
                                                  contract expires.

             C                                    I do not plan to sign a contract and live on campus for the next
                                                  academic year.
                                                       Residency Requirement no longer requires me to live on campus.
                                                        Application for Exemption has been submitted.
                                                        (Residence Life approval required)




          I understand that the deposit will not be placed in refund status until after I have been officially checked out of the
          residence halls and all applicable charges have been added to my student account. The refund will be first applied
          to any outstanding charges that I may have with the university and the remaining difference will be refunded to me.




              (Signature)                                                                            (Date)

              OFFICE USE ONLY:
                    Approved
                                    (Date)

                    Denied
                                (Reason)
              Term:                                  Champs             Peoplesoft               Other:

								
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