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
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Allow two weeks to process this form.
Committee Approval: Yes______ No______
Comments:_________________________________________________________________________________
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