Request to Cancel Charges Stated in the Agreement by bem21275

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									                                                                                                               GEORGE WASHINGTON UNIVERSITY
                                                                                                                REQUEST TO CANCEL THE
                                                                                                               UNDERGRADUATE HOUSING
                                                                                                                  LICENSE AGREEMENT
                                                                                                                FALL 2010 – SPRING 2011
A student may cancel their Undergraduate Housing License Agreement for campus housing only under the following circumstances listed in subsections of this form.
The student must notify GW Housing Programs in writing by completing the “Request to Cancel the Undergraduate Housing License Agreement” form. In the event
of cancellation, the student will be charged a cancellation fee as indicated. Notification will be sent to confirm your cancellation request. Cancellation fees are
assessed based on the postmark (if mailed) or date received (if hand delivered) of your written request. The cancellation policy below only applies from
the point of initial application through the start of classes (August 30, 2010 for Fall applicants or January 10, 2011 for Spring applicants).
Please complete the below form.
 Last Name                                            First                              MI              RMS ID           GWid Number

 E-Mail Address                                                                                                    Date of Birth (MM/DD/YYYY)

 Housing Assignment (Hall and Room)                                                                                Cell Phone or Current Telephone Number

Please indicate your reason for cancellation below.
               A. Third-Year and Fourth-Year Students Assigned to Housing:
                   - Prior to April 5, 2010 (for Fall 2010 applicants only), a third- or fourth-year student may cancel their housing assignment no later than April 5,
                2010 with no cancellation fee.
               B. Third-Year and Fourth-Year Students Assigned to Housing:
               - Prior to May 3, 2010 (for Fall 2010 applicants only), a third- or fourth-year student may cancel their housing assignment no later than May 3, 2010
               and only be assessed a cancellation fee of $300. Any third- or fourth-year student who requests to cancel their housing assignment after May
               3, 2010 will be financially responsible for their housing charges for the entire academic year
               C. Students Assigned to Housing after May 3, 2010:
               - When assigned after May 3, 2010 (for either Fall 2010 or Spring 2011 applicants), a student has five business days from the date of their initial
               assignment to cancel their housing assignment and only be assessed a $300 cancellation fee to be charged to their student account if not otherwise
               required to live in on-campus housing by the Residency Requirement. The cancellation period is not applicable to subsequent room reassignments or
               changes within the residential housing system. For cancellations after five business days, the student will be financially responsible for the housing
               charges for the entire academic year. Students who complete self check-in, gain access, or otherwise take physical possession of the assigned
               space forfeit the ability to cancel their housing assignment. After five business days, regardless of occupancy, the student will be assessed the
               entire housing charges for the entire academic year.
               D. Students Not Returning to the University:
               - A student not returning to the University will have their undergraduate housing license agreement cancelled. Such student will not be assessed a
               cancellation fee with proper documentation provided. Please indicate the specific reason below.
               _____ Graduation (end of Fall)                      _____ Academically Dismissed                  _____ Government Service
               E. Students Studying Abroad:
               - A student studying abroad in a GW recognized program will not be assessed a cancellation fee provided that documentation is provided verifying
               that the student will be studying abroad in a GW recognized program. Indicate term(s) abroad below.
               _____ Abroad Fall 2010 only                         _____ Abroad Spring 2011 only                 _____ Abroad Fall 2010 - Spring 2011
               F. Students Transferring to Another College or University or Taking an Academic Leave of Absence:
               - A student not returning to the University due to transferring must submit a copy of their official acceptance letter to another college or university with
               this form. A student taking an academic leave of absence must submit documentation from their GW school or college indicating an approved official
               leave of absence. A student transferring or taking a leave of absence will not be assessed a cancellation fee providing that proper documentation is
               provided verifying that the student will be transferring or taking a leave of absence.
               _____ Not Returning (prior to Fall)                 _____ Leaving Immediately                     _____ Leaving at the End of Fall 2010
Students assigned to housing via an advance application process or through the Squatter’s Rights process are not permitted to cancel under the terms outlined in
sections A-C of this form. Should a student, after withdrawing or taking a leave of absence, re-enroll at the University during a period covered by the Housing License
Agreement, the terms and conditions of the Housing License Agreement shall again be in effect unless the student is granted an exemption by the Director of GW
Housing Programs or designee.
I, (print name)                                                              , have fully read and understand the terms of the above cancellation policy as stated
in the Fall 2010 - Spring 2011 Undergraduate Housing License Agreement. All cancellation fees will be assessed to a student’s University account and are subject to
payment based on the University’s payment schedule. Please contact Student Accounts Services for additional information on payment schedules.

Student Signature: ____________________________________________                                                  Today’s Date: ____________________

        Return this Request to Cancel the Undergraduate Housing License Agreement and supporting documentation to:
         GW Housing Programs, 2129 Eye Street NW, Washington, DC 20052 Fax: 202-994-1422 gwhouse@gwu.edu

								
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