Housing Withdrawal Form

STUDENT INFORMATION
First Name:
Last Name:
Fordham ID:	A - - (enter numbers only)
Residence Hall:	Alumni Court South Arthur I Arthur 2 Campbell Hall Hughes House Martyrs' Court Jogues Martyrs' Court LaLande Martyrs' Goupil Queen's Court Roberts Queen's Court Bishops Queen's Court Johns Finlay Hall Loschert Hall Ohare Hall Salice Conley Hall Terra-Nova Tierney Hall Walsh Hall
Room Number:
P.O. Box:
Cell Phone Number:	- -
Email:
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:

PRIMARY REASON FOR WITHDRAWAL

Please Choose  One:

University Withdrawal

Leave of Absence

Dismissed from housing

Moving to LC housing

Graduating

Commuting

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 Other Please fill in your local address below (LOCAL ADDRESS must be filled out by students choosing to commute) Street Address:   Apt #: City 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: Name: Email address: I am not planning to come back to University Housing after my study abroad experience.

OTHER REASONS FOR WITHDRAWAL
Please Check All That Apply:
Academic	Financial
Transferring to another school	Medical
Disliked residence hall	Roommate Conflict
Other
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:

IMPORTANT NOTICE
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.