Name Student ID
Contact Phone Number Sycamore Email
Current Class Standing Incoming Student FR SO JR SR GR
Contract Type Residence Halls Apartments Family Housing
Release Request is for Full Contract Meal Plan Only Single Buyout Only
Current Housing Assignment Contract Complete Date
If granted, when would this release begin As soon as possible Fall Semester Spring Semester
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Date Received
by Res Life:
Received by:
I will be doing all online classes (class schedule will be verified)
I have specific special medical/psychological/psychiatric needs which require special accommodations that
cannot be accommodated in University housing (attach ARO accommodations letter)
There has been an extreme, unanticipated and unpredictable change in my/my family's situation that
happened after completing my housing contract and I now have a situation so unique that living off
campus is the only way to ensure my continued enrollment at ISU
(attach ISU Change in Situation Form)
Continued on Page 2
Housing Contract Release Application
I have military duty obligations (attach copy of official orders)
I have recently been elected to a live-in required officer position within my fraternity/sorority (Note: this does
not apply to first year students) (attach copy of chapter bylaws listing live-in positions and meeting minutes where elected)
I have accepted an employment position that requires me to live on-site at my place of employment
(attach
employment agreement documentation and tax forms from employer)
I will be a parent and will need to live with my minor child (attach copy of state Birth Certificate)
I will be married and will need to live with my spouse (attach copy of state Certified Marriage License)
2. Contract Language
The housing and dining services contract submitted to the University is a legally binding contract and creates a
financial obligation for the entire contract period. A student is released from that obligation only if the student cancels
enrollment with or withdraws from the University. If the contract holder is continuing enrollment at Indiana State
University, and wishes to be considered for release from the contractual obligation, this Housing Contract Release
Application Form , and any supporting documentation, must be submitted for review. Students are advised that a
contract release is considered only in certain unique situations, which are outlined below. A desire to experience off-
campus living is not a valid reason for a request to be released from a legally binding contract. The Housing and dining
services contract is a legally binding contract for the full academic year.
3. Reason for Contract Release Request (check all that apply)
1. Student Requesting Release (Print all information clearly)
I will have student teaching, an internship or other field experience more than 30 miles away from campus
that is for credit and/or required for graduation (attach copy acceptance letter , class schedule will be verified)
I will be studying abroad/away (attach copy of acceptance letter, final approval granted after class schedule is confirmed)
Important Note: You should NOT enter into a legally binding lease, other agreement, or otherwise financially
commit to off-campus housing if you have not been released by the Office of Residential Life. If you were to do this
you would be under a financial obligation for two different places to live.
You may continue on additional pieces of paper, if necessary, and attach those to this form.
Student's Signature Date
2/22
Additional Documentation Requested
Date Reviewed Approved Denied Effective Date at move-out
Rationale
By
Additional Documentation Requested
Date Reviewed Approved Denied Effective Date at move-out
Rationale
By
Date Buyout Requested Buyout Amount $
Contact Residential Life with questions at 812-237-3993 or [email protected]
5. Student Signature
a. all the information provided is true and correct at the time of application; b. returning this form does not guarantee
approval; c. you will be sent a decision to your ISU email account within 30 business days of the date all information is
received; d. each request is considered on a case-by-case basis by reviewing all the information you provide; e.
information about submitting an appeal of the initial decision will be sent if the request is denied.
4. Statement of Request
State a detailed explanation of request and rationale for this contract release
(attach supporting documentation as necessary)
Housing Contract Release Application Form, Page 2
Initial Review (Office Use Only)
Appeal Review (If Needed)
Contract Buyout (If Needed)
Name Student ID
Contact Phone Number Sycamore Email
Approximate Date of Change Nature of Change Temporary Permanent
Requested Residence Address Street
City State ZIP
Requested Residence Type Parent's Home Student's Home Other
Your Monthly
Rent $ Water $ Natural Gas $ Electric $
Estimated Expenses
Phone $ Internet $ Transportation $ Food $
Yes No N/A
If yes, you should obtain a copy and attach it to this form.
Change In Situation Form
1. Student Information (Print all information clearly)
Important Note: You should NOT enter into a legally binding lease, other agreement, or otherwise financially
commit to off-campus housing if you have not been released by the Office of Residential Life. If you were to do this
you would be under a financial obligation for two different places to live.
2. Proposed Residence Information
Breifly explain how you arrived at these monthly estimates and, if applicable, any cost sharing you would do with
roommates and others. Also, provide details on your plan for transportation to/from campus.
Provide a brief explanation of your proposed residence and details about any roommates you may have.
Continued on Page 2
Have you reviewed the actual lease / agreement for this residence?
You may continue on additional pieces of paper, if necessary, and attach those to this form.
Student's Signature Date
Date Received by Res Life: Received By:
2/22
Explain the recent extreme, unanticipated and unpredictable change in your/your family's situation. You must show
how this change is so unique or of such a severe nature to your life (such as financial, medical, traumatic loss, natural
disaster, etc.) that without a release from your housing contract with Residential Life you would not be able to
continue your enrollment at ISU.
Change in Situation Form, Page 2
Contact Residential Life with questions at 812-237-3993 or [email protected]
4. Student Signature - By signing below, you understand and agree that:
a. all the information provided is true and correct at the time of application; b. returning this form does not guarantee
approval; c. each request is considered on a case-by-case basis by reviewing all the information provided.
3. Statement of Change
Attach copies of any documentation, receipts, statements, etc. that would support your case.
While nothing specific is required, it is best to support your case with as much complete and
accurate documentation as possible.
