Housing Agreement Cancellation Request

This form is to request the release of the 2020-2021 Housing Agreement. If you are a first or second year student, you must have an approved exemption from the Office of Residence Life and Housing before completing this form. Be aware that the contract is a legal binding document and charges will remain on your account until granted a cancellation.

PERSONAL INFORMATION

Request purpose *

Cancel a current agreement (moved in)

Cancel a future agreement (not moved in)

CSU-Pueblo Identification Number (PID): *

CSUP Email *

Last Name *

First Name *

Preferred Contact Number *

RESIDENCE HALL ADDRESS

Building/Hall *

Room Number *

TERMINATION CRITERIA

Term canceling *

Year canceling (Example: 2016) *

Reason for Termination *

Other:

Have you been granted an exemption or been released from the agreement? *

I am not bound by the live on requirement (see criteria on our website)

Yes

No

Other Other

CHECK OUT

Have you already moved out of University Housing? *

Yes, please provide the dates in the boxes below.

No, please provide the dates you'd like to check out in the boxes below.

I have not moved into University Housing (never moved in)

Check-out Date: * +

Check-out Time: *

By checking 'I Agree', you are stating that you understand your financial obligations to the University Housing Contract. *

I Agree

By checking 'I Agree', you are stating that you understand that you must be officially checked out of your room and the residence hall by the above listed date and time. You are also stating that if you are not officially checked out, you understand that you will be assessed an improper checkout fee and/or additional late checkout penalties. *

I Agree

Student Signature: *

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