LEASE CANCELLATION REQUEST FORM
1 Your Lease Agreement binds you financially to your housing assignment for the entire lease term. By completing
this form you are requesting a release from the financial responsibility of your housing assignment. There is no
requirement for Fayette Square to allow release of the Lease Agreement outside the terms stated in the agreement. A
release from the Lease Agreement depends on the approval of this request. All requests will be reviewed on a case-
by-case basis, therefore please allow at least 15 business days for a decision to be made and communicated to you in
writing. Please be clear in providing your current contact information and attach the required supporting
documentation. As per the Lease Agreement, the $300 room holding deposit will be forfeited to Fayette Square if
your Lease Cancellation Request is approved. Initial: ____________ (I have read and understand this information).
2 Please Print
University ID: Requested Check Out Date:** / /
Last Name: First Name:
Fayette Square Address: UMB School of Study:
Fayette Square will contact you using the information you provide below.
Preferred Email Address: UMB Email Address:
Phone: ( ) Alt. Phone: ( )
City: State: Zip:
** For information only. If your request is approved, charges will be adjusted based on date reflected on your official check-
out form. (See reverse)
3 REASON FOR REQUEST (Please INITIAL the reason that applies to you)
Graduation (a) Please attach required documentation (see reverse). Conditional releases will
Withdrawal (Non- be given for these requests pending final verification. If Fayette Square is
Enrollment) (b) unable to verify these conditions, the request will be denied and you will
Academic Internship or remain financially liable for the entire lease agreement term, including
University Approved Study miscellaneous charges assessed by Fayette Square. If reasons are officially
Abroad program (c) verified, charges will be adjusted based on actual check out date found on
the official check-out form.
Military Duty Activation (d)
Please attach required documentation (see reverse). Requests that do not
meet the options listed above will be considered and decided upon by the
review committee. You will remain financially liable for the entire term,
including miscellaneous charges assessed by the Fayette Square. If the
request is approved, charges will be adjusted based on actual check out
date found on the official check-out form.
Any financial adjustments will be made according to the date of check out in accordance with the guidelines on
reverse. Initial here: ____________________
4 The following option is available for those students not petitioning based on reason (a-d) as noted above.Fayette
Square will transfer your lease to the next applicant of the same gender and apartment request type on the waitlist
when there are no vacancies at Fayette Square. Priority of petitions for lease cancellation will be granted based
on DATE RECEIVED. Release is not granted until a completed lease is signed by a qualified waitlist
5 Please acknowledge that you have read and understand the Request for Lease Agreement Release Guidelines on
the reverse side by initialing here: _________________ (required for processing)
6 All information on this form and in the required documentation is true and complete to my knowledge. I
understand that falsification of information can lead to my request being nullified. I understand that this is only a
request and is subject to the release process as explained in the Request for Lease Agreement Release Guidelines on
the reverse side of this form. Fayette Square reserves the right to review each request on a case-by-case basis. (This
form must be completed in its entirety to be considered and must be accompanied by required documentation, or it
will be returned to the student in DENIED status).
Student Signature: Date: / /
For Office Use Only
Date Received: Staff Initials:
Decision: Notification Date:
New Lessee Name: Date New Lease Signed:
Lease Agreement Release (LAR) Request Guidelines
You are requesting a release of your financial obligation for the 2009-2010 lease term with respect to your
Choosing to leave your housing assignment does not release you of your financial obligations agreed to by your
original lease agreement. Your lease agreement is for the entire lease term.
If your request to be released from the lease agreement is approved your room charges will be adjusted based on
the date on the official, signed check-out sheet.
As per the Lease Agreement, the $300 room holding deposit will be forfeited to Fayette Square if
your LAR is approved.
No financial adjustments will be made and no refunds will be granted for approved LARs with check-out dates on
or after September 7th, 2009 for Fall releases.
No financial adjustments will be made and no refunds will be granted for approved LARs with check out dates on
or after February 5th, 2010 for Spring releases.
If your request is denied you are fully responsible for all of your lease fees for the entire lease term.
Should you check out of Fayette Square prior to a decision on your LAR request and later opt to return following a
denial please be aware that your original assignment may not be available. Re-assignment will be made based on
Submit the completed LAR request and required documentation to the Fayette Square Office; attn. General
You will be notified via letter and/or email with our final decision.
Allow fifteen business days from date of approval or date of official check-out following approval, whichever is
later, for adjustments to be posted to your Fayette account.
REQUIRED DOCUMENTATION FOR LAR REVIEW
Graduation Official communication confirming application for graduation
Withdrawal (Non- Official Enrollment Verification Letter from Registrar’s Office
Enrollment) confirming withdrawal for respective semester(s).
Official communication from associated school confirming
Academic Internship or academic internship or study abroad program dates requiring
University Approved Study students to live off campus and confirming that the academic
Abroad Program internship program is located more than 30 miles from campus.
Military Duty Activation Official United States document ordering military duty
Letter from student detailing circumstances and:
1) Medical: Letter from a physician who has been treating the individual
providing justification and specifying the special accommodation or need of the
resident which cannot be met by Fayette Square (must be a verifiable medical
reason). Corroboration from a second physician may be required.
2) Financial Hardship: Student must provide proof of a substantial change
in the person’s financial situation from the time the lease agreement was signed
to present (i.e. bank statements, employment termination letter etc.), must
Please circle which option
have exhausted all available options for obtaining financial aid (including taking
you are submitting as
out loans from private providers), and must be moving to the home of a parent
reason for request:
or guardian whose primary residence is located within 30 miles of the UMB
1 2 3
Campus. Student should submit a copy of their “Award Package by Academic
Year” that can be printed off of SURFs.
3) Other: If your reason does not fall within one of the above
categories and fulfill the required guidelines, your request will not be
considered until such time that Fayette Square can transfer your lease
to a qualified applicant on a waitlist (Fayette Square must have no
vacancies for this option).
SCHEDULE OF FINANCIAL RESPONSIBILITY
(in accordance with UMB Policy)
Approved withdrawal during 1st
No liability for lease agreement fee
week after check-in
Approved withdrawal during 2nd
Liable for 33.3% of lease agreement fee
week after check-in
Approved withdrawal during 3rd Liable for 66.7% of lease agreement fee
week after check-in
Approved withdrawal starting 4th
Liable for 100% of lease agreement fee
week after check-in
Unapproved withdrawals Liable for 100% of lease agreement fee