Fordham University            The Jesuit University of New York

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Housing Withdrawal Form

Housing Withdrawal Form

First Name:
Last Name:
Fordham ID: A - - (enter numbers only)
Residence Hall:
Room Number:
P.O. Box:
Cell Phone Number: - -
Gender: Female Male
Please choose one of the statements below that applies to you
"I am vacating my room immediately for this semester and will return my keys and ID to the Office of Residential Life within 24 hours or I will be billed appropriately"
"I will remain in University housing until the end of this semester but am withdrawing from University housing for next semester as I will not be living in University housing next semester"
Please enter the date in which you plan to vacate your room Select Date:


Please Choose  One:
University Withdrawal
Leave of Absence
Dismissed from housing
Moving to LC housing
Please choose where you will be commuting from: With family off campus
On own off campus
How important were each of these factors in your decision to move out of the residence hall?
(1 = Important, 2 = Moderately Important, 3 = Very Important)
Cost of Housing/Financial Reasons 1 2 3 N/A
Roommate Concerns 1 2 3 N/A
Residential Life Policies 1 2 3 N/A
Meals: I want to prepare my own meals 1 2 3 N/A
Please fill in your local address below
(LOCAL ADDRESS must be filled out by students choosing to commute)
Street Address:
Apt #:
Zip Code
Study Abroad
(Please fill in your proxy info below)
I am planning on returning to University Housing after my study abroad experience and have assigned the following person to be my proxy for the housing lottery:
Email address:
I am not planning to come back to University Housing after my study abroad experience.

Please Check All That Apply:
Academic Financial
Transferring to another school Medical
Disliked residence hall Roommate Conflict
If "Other", please explain: 
(20 character limit)

By entering your initials in the following box, you certify the below statement:
"I certify that I have read all of the information on this form and have reviewed the Housing Assignment Confirmation. I am aware of the housing refund calendar."

Please enter your initials:

If you choose to withdraw from housing for any reason except Study Abroad, youwill no longer be guaranteed housing at Fordham University. If you are taking a Leave of Absence, you must go through the Re-Entry Process in order to be considered for University Housing.

If you are studying abroad, your $100 will be held as a credit to be applied toward the following semester, or you can request a refund from the Bursar’s office if your account has no balance.  

Students not studying abroad or transferring to Fordham University Housing at Lincoln Center: 
If you withdraw before June 1st your $200 housing deposit will be credited to your student account.  If you withdraw from June 1st through June 30th you will receive a 50% refund of your deposit.  Withdrawals from July 1st through July 31st will result in a 0% refund of the housing deposit.  Please be advised that if you withdraw from August 1st through Opening Day you will not receive your deposit back and will be charged a $350 late withdrawal fee.  Please refer to our refund calendar for withdrawals that occur after Opening Day. 

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