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Residence Life

Change of Resident Status Notification

 

First Name:

Last Name:

 

Student ID#:

 

Cell Phone:
xxx-xxx-xxxx

 

Change Effective as of (date):
mm/dd/yyyy



MOVING FROM:

 

Building:


Room:

Box Number:

Phone Number:
xxx-xxx-xxxx

 

MOVING TO:

Building:


Room:

Box Number

Phone Number:
xxx-xxx-xxxx


 

IF MOVING OFF-CAMPUS, PLEASE LIST ADDRESS:

 


Please Select:

 

















 


Residence Hall Survey

 

Gender:


 

Resided in:



3


House #:

 

Year in School:





 

Number of Years Lived in the Residence Halls:






 

Reason for Leaving the Residence Life Program:

 

Thank You!!




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