Electronic Mail

housing@case.edu

Resident Information (please print)

Student ID
Network ID

@case.edu
Your status is always available on the Internet:
http://housing.case.edu/myhousing

FAX

(216) 368-6658

Telephone

Case Western Reserve University

Residence Life & Services

(216) 368-3780

Housing Release Request

Use this form only if:
You are an undergraduate requesting to be released from the campus housing requirement
Your financial aid package may be impacted if you are released from housing. Please check with the financial aid
office before pursuing this option.
Last Name

First Name

Effective Semester
Summer 2015 Fall 2015 Spring 2016

Room Assignment

Reason for Request (choose only one)

Commuting from Home (parent must complete below)
Married (attach copy of marriage certificate)
Medical (requires approval from Disability Resources)
Meal Plan Cancellation

Religious (attach letter from clergy)

Financial (requires meeting with Financial Aid)
Other (use back or attach explanation)

If approved for a housing release, you can either request to have your meal plan cancelled or you can keep your
meal plan for the academic year. Please make a selection:
Cancel my meal plan for 2015-16
Do not cancel my meal plan for 2015-16

Signature
The committee will review your request under the guidelines established in the Residence Hall Agreement. If your request requires
a meeting with the Director, you will need to schedule an appointment. You will receive an email message informing you of the
outcome. You are responsible for the room and any associated charges until that time or through the contract period if your request
is denied. You may be charged a cancellation fee for this change; see the Residence Hall Agreement for details

Resident Signature

Date

This form must be returned to Yost 35

with any supporting documentation.

For Office Use Only

2 March 2015

CH MD FN Other:

Approved
Hold
Denied

Completion Stamp
Date

Housing Official

Cancel $200
Cancel 20%
Daily Rate

Greek Chapter Approval

A chapter officer must sign this section if you are an active member of a Greek organization as recorded by the Office
of Greek Life. Your request will not be processed without this approval. If your chapter will not grant its approval, you
must appeal through the process established by that organization before submitting your request.

Chapter (choose one)

Signature

We understand that the applicant has requested a release from the campus housing requirement and any current contracts. As an
authorized officer of the organization marked above, I am verifying that our member does not have any obligation to live in our
house (or designated residence hall area). We understand that our approval does not guarantee that the applicant will be released.

Chapter Officer Signature

Date

Position

Commuter Confirmation
This section must be completed if you wish to commute from a parent or guardians permanent home within 40 miles
of the CWRU campus. You may also attach a signed letter which includes the same information.

Address Information (please print)

Street Address
Telephone

City
Name of Telephone Listing

Distance in Miles to Case

<5 5-25 26-40

>40

Signature
As a parent or legal guardian, I verify that the applicant intends to live in my/our home at the address and telephone number listed
above. I understand that if the applicant or I move from this location, a release automatically terminates and s/he must return to
campus housing or obtain a new release. I understand that this request will be reviewed in accordance with CWRU residency policy
and the Residence Hall Agreement (if applicable), and that my approval does not guarantee that the applicant will be released.

Parent/Guardian Signature

Date

Relationship