Housing Excuse Form

Any student wishing to live off campus must complete a Housing Excuse Form each semester.  Each request will be reviewed by the Dean of Student Life.  This form must be on file in the Office of Admissions before confirmation of classes can be completed.

Filing of this form with the Office of Student Services does not represent a cancellation of any residence hall room reservation.  It is the student's responsibility to make all cancellations through the Registrar's Office.

DATE: ____________________
NAME: ________________________________________  ID No.: ____________________
DOB: _________________________  Marital Status:  S ________  M ________
Local Phone: ______________________  Current Mailing Address (Include Apt#, City, and Zip)
_______________________________________________________________________________
Home Address:  __________________________________________________________________
Cumulative Hours Completed: ________  Number of Hours Currently Enrolled: ________
Cumulative GPA: _______
REQUEST (please provide information you feel will be pertinent in helping us make a decision regarding your request)
________________________________________________________________________________
________________________________________________________________________________
ADDRESS WHERE YOU PLAN TO LIVE: _____________________________________________
PHONE NUMBER WHERE YOU PLAN TO LIVE: ___________________________
WITH WHOM DO YOU PLAN TO LIVE? __________________________________
RELATIONSHIP TO YOU: ______________________________________________
This application is being made for _________________ semester ___________________ year.

I have read the Cumberland College Student Handbook and recognize that I must abide by all College regulations, regardless of my place of residence.  I further understand that any failure to abide by these policies, or if I should be placed on academic probation, may result in my being required to reside in a College facility.

_____________________________________     __________________
                       Student Signature                                                              Date
 

Office use only

                    Approval by:                                                          Approval Date:
                    ______________________                                 __________________

Deliver this completed form to the Office of Student Services or mail to this address:

Office of Student Srevices
7197 College Station Drive
Williamsburg, KY  40769

In order for a student to live off campus, one of the following criteria must be met. The student must be/have:

1. married;
2. living with a parent or guardian;
3. disabled person as defined by Section 504 of the Rehabilitation Act of 1973
    and required, as an accommodation, exemption from this policy.

Any student who has not been excused from compliance with this policy prior to September 1, 2003, may complete a Housing Excuse Form. If excused and granted the privilege to live off campus, the student will forfeit eligibility for, and will forfeit any previously awarded, but not received, private grants from the College, (page 149, 2003-2004 Cumberland College Student Handbook).

Any student on academic probation, except those covered by conditions 1, 2, or 3 above, may be asked to move into College housing until probation is lifted. The College is exercising this option.