Petition to be Released Housing and or Dining Membership Agreement by johnrr1


									Petition to be Released: Housing and/or Dining Membership Agreement
Residence Life and Housing

please print legibly Name: Gender: M F Current Year: FR SO JR SR Student ID #: Current Dining Plan: Campus Email: Current Assignment :

I am requesting to be released from my Housing Agreement for the spring 2009 semester for the following reason(s):

Study Abroad Program
Proxy Information: I am allowing (name):____________________________________ (email) ________________________ to act as my proxy for the room selection process for the 2009-2010 academic year. I understand that it is solely my responsibility to ensure my proxy represents me in the correct room selection process (es) and/or completes the necessary room selection and dining membership forms. I understand that by choosing this option, I am financially responsible for housing and dining charges upon my return from Study Abroad. I will accept the room and dining membership selection made by my proxy and understand that any failure by my proxy to select a room and dining membership will result in a status change from “Resident Student” to “Non-Residential (Day) Student” and subsequent loss of guaranteed campus housing. Note: Resident status will be maintained and a point for housing will be added for those students participating in an approved University sponsored academic program.

Discontinued Enrollment at Wake Forest University
Graduating Transferring Withdrawing

Note: Discontinuing enrollment results in a review of your residency status upon re-enrollment to Wake Forest University at a later date.

Other (please attach supporting documentation)
SPECIAL NOTE: If you are planning to continue enrollment at the Reynolda Campus and desire to move off campus, you should not enter into any off campus housing arrangements prior to being officially released, in writing, from your Housing Agreement. Petitions for release to move off campus or from dining memberships are not guaranteed. Each petition will be reviewed on an individual basis. Please attach any additional documentation necessary to support your desire to be released from your Housing and/or Dining Membership Agreement. If you are released from your Housing and/or Dining Membership Agreement, you must also apply to live off campus through the Off Campus Housing Policy process.

Dining Cancellation
If released from my Housing Agreement: I wish to continue my Dining Membership Agreement. I wish to apply to be released from my Dining Membership Agreement. All signed Petitions to be Released from Housing must be submitted to the Office of Residence Life and Housing, Benson 101, before noon, Monday, November 3, 2008. If a petition is approved, the student will be free from financial obligations of housing rent charges for spring 2009. Students submitting a Petition to be Released after November 3, 2008 will be charged and held accountable for a Cancellation Fee as noted on the back of this form, even if the petition is approved. I understand that release from my Housing Agreement does not guarantee release from my Dining Membership Agreement. I understand and will abide by all terms and conditions of the Housing and Dining Membership Agreement. I certify that the information supplied in support of my petition for release is true and correct. I understand that approved releases will be subject to verification and if found to be falsified, housing fees and/or dining fees will be reactivated and I will be referred to the judicial process. I have read, understand, and agree to abide by the terms stated on this petition. Signature: Date:

Residence Life & Housing ● ● 336.758.5185 ●

Petition to be Released Forms Due Residence Life & Housing, Benson 101 12 noon, Monday, November 3, 2008 Decision letters will be emailed to WFU email addresses Friday, November 21, 2008 Must be completed within 24 hours of your last exam or no later than 7 p.m., Saturday, December 13, 2008.

Petition to be Released Decisions

Check-out of Current Assignment

• • • •

You should complete this form if you are leaving campus housing for any reason. Cancellation of your Petition to be Released request must be made in writing to Residence Life & Housing, Benson 101, no later than 12 noon, Tuesday, November 4, 2008. All housing and dining membership charges will continue to accrue and are the responsibility of the student until the student is officially released, in writing, from the Housing and/or Dining Membership Agreement. If you have a roommate, please be courteous and notify them of your intention to leave campus housing so they have the opportunity to pull-in a new roommate of choice.

Cancellation Fee Schedule Students submitting a Petition to be Released form after November 3, 2008 may be held accountable for a Cancellation Fee, even if the petition is approved.

Residence Life & Housing ● ● 336.758.5185 ●

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