Request to Terminate Student Housing Contract

							 DEPARTMENT OF HOUSING,
 RESIDENCE LIFE, AND STUDENT CONDUCT
 Division of Student Affairs
 University Center 250

 2000 Clayton State Blvd.
 University Center 250
 Morrow, GA 30002

 Phone: (678) 466-5444
 Fax:   (678) 466-5469


                      Request to Terminate Student Housing Contract
 _________________________
 Today's Date

 _____________________________________________________________________________________________________
 Name (print)                         Housing Building & Room          Laker ID #

 ____________________________________________________________________________________ @student.clayton.edu
 Housing Mailbox #                     Telephone #                     Email Address


 I am requesting termination of my Housing Agreement for:               Fall Semester        Year: _________

                                                                       Spring Semester Year: _________

                                                                       Summer Term           Year: _________

The reason for my cancellation is*: ______________________________________________________________________

My signature indicates that I request termination of my student housing agreement effective the ___ day of ______________, 20____.
I understand that, upon approval of my housing contract termination, I will have the following financial obligations:

    •    I will be required to pay for any damages to my room or common area (if already moved in);
    •    I will forfeit my Housing Reservation Deposit (if not yet applied to my charges);
    •    I will owe, at minimum, a Housing Contract Cancellation Fee and forfeit any fees paid for the current semester.
         (e.g. if you cancel halfway through the Fall Semester, then you will forfeit the housing fee already paid for the
         Fall Semester plus be required to pay a cancellation fee.

I also understand that, if my contract termination is approved, I agree to move out of the Laker Hall within 24 hours of the
effective date listed above or by the date listed below, whichever first occurs. I must complete a Vacate Room Checklist
through Laker Hall staff which includes returning my room keys, mailbox key, access card, and residential parking decal.

I am aware that an approved contract termination means that I am giving up my room assignment and that, as such, the University
makes no guarantees of room availability in the event I change my decision to terminate after submission of this form. In addition,
if I have live-on-campus-required freshman student status, I will be restricted to part-time enrollment for remainder of my first
academic year.

IF YOU REQUEST TO TERMINATE A CONTRACT, BUT CHOOSE TO OCCUPY YOUR ROOM THROUGH THE END OF THE SEMESTER/TERM,
YOU MUST VACATE YOUR ROOM AND LAKER HALL 24 HOUR AFTER YOUR LAST FINAL EXAM (AND NO LATER THAN THE PUBLISHED
FINAL MOVE-OUT DATE OF THE TERM. OTHERWISE YOU WILL INCUR ADDITIONAL CHARGES.

____________________________________________________________________________________________________
Student Signature                                                Date

_____________________________________________________________________________________________________
Forwarding Street Address                         City                 State               Zip Code

*Documentation substantiating reason for termination must accompany this Request to Terminate form. A student who makes a
request to terminate for reasons other than the eligible reasons stated in the official contract will be held financially accountable for
the FULL term of the housing agreement.