Petition for Village Residence

Students under the age of 21 who are in undergraduate programs are required to live in campus residential halls unless they are married or live with their parents. A student who desires to live off-campus, but who does not meet the necessary qualifications, must file a petition with the Dean for Student Affairs.

This petition for community residence is to be presented to the office of student affairs and must contain the following information:

LAST NAME:____________________________FIRST NAME:_________________________

DATE:____________________ GENDER:_________ SS#:____________________

PARENT'S CURRENT HOME ADDRESS:___________________________________________________

YOUR CURRENT HOME ADDRESS:_______________________________________________________

TOTAL QUARTER UNITS COMPLETED:_________ TELEPHONE: (.....) _______________

SCHOOL AND PROGRAM:___________________________ CLASS:___________________

AGE:_______ DATE OF BIRTH:________________

Proposed address and phone # of applicant:_________________________________________
(Please include a letter of invitation from relative with whom you are petitioning to live with)

Name(s) of others sharing residence:______________________________________________
(if sibling, include age/marital status)

Relationship to you:_________________________________

Monthly cost to you of rent:______ utilities:______ transportation:______ food:______ Total:______

Proposed move-in date:________________

WRITE A STATEMENT SUPPORTING YOUR REQUEST TO LIVE IN THE COMMUNITY:
(Please be detailed and specific. Use the reverse side if you need more space.)

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Student Signature

Committee Approval: Yes______ No______

Comments:_________________________________________________________________________________
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