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Request for Release From Contract

* Denotes required fields
Last Name:*		First Name:*
Email:*		Phone #:*
Date of Birth:*		Student ID #:*
Class Standing:*		Residence Hall:*
Room #:*		VSU Box #:

I am requesting release for the following semester(s). Please indicate all that apply:*


I am requesting release based on the following circumstances. Please Note: You MUST check one and provide the requested information; otherwise, your request will be returned to you unprocessed.*
I am graduating. I am getting married. Date of Wedding: Medical withdrawal from the University. Participation in a Valdosta State University program requiring residency off-campus. (An e-mail letter from your advisor or programming supervisor must be received by housing@valdosta.edu before this request will be processed.) I desire to buy out the remainder of my contract for 50% of the remaining contract value.* Other reason.* (If you choose this option you MUST write the rationale below AND attach any cited sources of documentation. You are subject to the 50% buy out.)

* If student requesting release is a continuing freshman at Valdosta State University, the Freshman Residency Exemption Form must also be completed and approved.

*I would like to keep my meal plan. I would not like to keep my meal plan.
*I will continue as a student at Valdosta State University. I will not continue as a student at Valdosta State University

Forwarding Address:
Street:*		City:*
State:*		Zip Code:*

Students who request release from their contracts after the deadlines will be required to pay all fees. After the Housing Contract Appeals Committee reaches a decision, you will be notified by mail. If you are released from the contract, all refunds must be requested through the Office of Housing and Residence Life and all payments made to VSU.
DEADLINES
Spring	Nov 15th
Summer	April 15th

By submitting this form, you hereby ascertain that the information provided above is accurate.