UNIVERSITY RESIDENCE HALLS & APARTMENTS RESIDENTIAL OPERATIONS OFFICE 106 SPAULDING QUAD
2009-2010 Agreement/Lease TERMINATION form
Return this form to the Residential Operations Office – 106 Spaulding Quadrangle
NAME: _______________________________________________________________________________________
LAST NAME FIRST NAME MI
PN#: __ __ __ __ - __ __ __ __ CELL/LOCAL PHONE: ( I am a:
) ___________________________
GENDER:
(Circle one)
Male
Female
EMAIL ADDRESS:________________________________ Current Apartment Resident Current Address:__________________ Start Date __ __/__ __/__ __ Start Date __ __/__ __/__ __ Start Date __ __/__ __/__ __ Start Date __ __/__ __/__ __ Start Date __ __/__ __/__ __
New/Incoming Apartment Resident
I have been assigned to: Creekside Village, Apt #_____________ Flint Village, Apt #_________________ Flickinger Court, Apt #______________ Hadley Village, Apt #_______________ South Lake Village, Apt #____________ Apt Size:_____________ Apt Size:_____________ Apt Size:_____________ Apt Size:_____________ Apt Size:_____________
Reason for Termination:___________________________________________________________________
_________________________________________________________________
The student completing this form has read and understands the following: 1. I am requesting a termination of my 2009-2010 Agreement/Lease. I understand that this choice does not terminate my current
2008-2009 Agreement/Lease with the University Residence Halls & Apartments (if applicable).
2. I understand that this termination request does not guarantee a refund of my pre-occupancy security deposit. This form must
be received by the Residential Operations Office on or before 45 days prior to the start of my 2009-2010 Agreement/Lease. If I choose to submit this termination request after the 45-day deadline, I understand that, in addition to the $450.00 termination fee, I may incur charges until my apartment space is leased to a new resident. Hadley Village and Flickinger Court Lease terminations are reviewed on an individual basis; refund amounts are based on this review. If you are eligible for a refund, it will be processed 6-8 weeks from the receipt of this form. Current apartment residents, if eligible, will receive the refund, minus any damages found in your current apartment after you vacate, 6-8 weeks after your current Agreement/Lease end date. Please forward my refund (if applicable) to: Address:_____________________________________________________________________________________
(Street) (City) (State) (Zip)
3. By signing this form, I agree that I have read the above-detailed information and that I understand the Agreement/Lease
termination process. I also agree that I have read the Terms & Conditions of my Agreement/Lease and understand my responsibilities as an Agreement/Lease holder.
Student Signature:_________________________________________________
For Office Use Only:
Date:_____________
Gender:_______
Application Type:___________________ Bookings Deleted: #1____________________
Apt #:___________________
Size____________
#2____________________
#3____________________
RMS Notes:__________________________________________________________________________________________