Request Contract Release

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					                                                                              Office of Residential Life and Food Service
                                                                             Telephone: 941-487-4259; Fax: 941-487-4517
Request for Release From Residence Hall Contract(s)

Date ________________Student Name (Print) _______________________________________ Box __________________

Student ID: ______________________ Room Number _____________ Current Phone Number ___________________

Email _______________________________________________________________________________________________

Academic Year to be released __________________ (eg 2008/09)

I would like to be released from my Residence Hall Contract(s) on ____________________________(date).

Address to which refund should be sent if a credit balance results from the credits applied: ______________________



I will be (check one) _______ Graduating _______ Doing Off Campus Study _______ Going On Leave Of Absence

_______ Withdrawing         _______ Moving Off Campus         _______ Other;     If moving off campus or "other" please
give a detailed explanation of why you want to be released. Remember that releases are at the discretion of the Office of
Residential Life and Food Service and may be denied. Attach documentation information and additional sheets if needed.

Failure to vacate the room by 11:00 a.m. on the approved Release Date will result in extra room charges
of $50/day beginning with the Release Date. At least a week prior to the check-out date please make an
appointment to check out of your room. Room Damages, if any, will be charged to the student's account
before any credits are applied. Students still attending New College but moving off campus within the first 10 days of
the semester may change their meal plans to Commuter by filling out a food service contract addendum form in the Office
of Residential Life and Food Service. After that they must keep their current meal plan for the remainder of the semester.
The credit for the meal plan buying power will not exceed the student's remaining balance on his/her food card.

Terms acknowledged by:____________________________________________________________ (Student Signature)
The following is to be completed by Residential Life staff: Date ________________________

Request for release is (circle one): Approved Denied Staff Signature: __________________________________
Date _________________ Keyed by ____________
                                                     DCode      Description           Amount        TNum
SLMP ____ Banner _____ FS Addendum ____

_____ Banner _____ Student File _____ Release File

Description: Request Contract Release document sample