petition to be released from the housing contract - College of William ...

PETITION TO BE RELEASED FROM THEHOUSING CONTRACTThe Housing Contract covers an entire academic year, fall and spring semesters. A student will only be released from his/herHousing Contract for the following reasons:(1) He/She gets married. A copy of the marriage certificate is required for verification.(2) He/She is accepted in a William and Mary approved Study Abroad program. Verification must be received from the RevesCenter.(3) He/She is academically dismissed. Verification must be received from the Dean of Students Office or the student's graduateprogram.(4) He/She is required to withdraw due to medical reasons. Verification must be received from the Dean of Students Office.(5) He/She transfers to another institution. A copy of the acceptance letter to the institution is required for verification.(6) He/She is released by the Contract Release Committee due to extraordinary circumstances.CONTRACT RELEASE REVIEW COMMITTEEThe Contract Release Review Committee consists of three campus administrators. The Associate Director of ResidenceLife sits on the Committee ex officio.A student making a request to be released from the Housing Contract is asking for an EXCEPTION. Anapproval of the petition is NOT automatic and is generally given only for extraordinary circumstances.Signing a lease or purchasing a home off campus does not in and of itself constitute ‘extraordinarycircumstances’.DEADLINE FOR REVIEWPetitions with supporting documentation must be submitted to Residence Life, Campus Center 212, or faxed tothe office (757-221-1240) and generally will be reviewed during the first and third weeks of the month. Thestudent will be contacted regarding the committee’s decision with an e-mail to their W&M e-mail address.SIGNATUREThe petitioner must sign the form to indicate that the requested action is the student’s intention.SUPPORTING EVIDENCE/DOCUMENTATIONIt is the student’s responsibility to furnish the Contract Release Committee with appropriate supportingdocumentation. Examples may include: financial statements, if claiming financial hardship; letter from theResident Assistant explaining the mediation process, if claiming roommate conflicts; statement ofrecommendation from a health care provider, if claiming medical problems; etc. Requests made for medicalreasons may be forwarded to the Medical Review Committee for review.CHECK LISTo Contract Release Petition page and question responses on separate sheet(s) of papero Contract Release Financial Information sheet (only if requesting release based on financial reasons)o Signed Contract Release Commuter Request Form (only if requesting to live with a parent/guardian)o Any additional supporting documentation/evidence

CONTRACT RELEASE PETITIONPLEASE PRINT IN INKLAST NAME FIRST NAME MIDDLE INITIALSTUDENT I.D. NUMBERSEX: Male Female WILLIAM & MARY E-MAIL ADDRESS:CLASSIFICATION: Freshman Sophomore Junior Senior GraduateROOM ASSIGNMENT:ROOM NUMBERBUILDING OR HOUSEROOM ASSIGNMENT IS A:Main campus single Main campus double Main campus triple Main campus quadNicholas or Cabell Apartment Ludwell double apartment Ludwell apartment One Tribe PlaceOvercrowd room Lodge Tribe Square Grad double/triple/quad apt.On a separate sheet discuss the following:1) Reasons for your request to be released from your Housing Contract. Include in your explanation why your case isextraordinary.2) Explain how your situation has changed since you signed your housing contract or selected housing online.3) Explain why moving to another residence hall room would not solve your situation.4) Describe the resources you have used on campus to help you with your current situation. If you are requesting a releasedue to a roommate conflict, what avenues have you pursued to help with the conflict?5) Explain how off-campus living will help your situation.The Honor Code encompasses a wide range of behaviors which have specific importance to your petition.Honesty in presenting all the facts necessary for the Committee to make an informed evaluation and decision isexpected. Your signature below verifies your understanding of the Honor Code as stated in the studentHandbook and its relevance to the following request.STUDENT’S SIGNATURE (Required):DATE:Don’t forget to include all supporting evidence/documentation!

Contract Release Financial InformationThe following criteria will be used when making decisions based on a financial change.• Do you have any financial aid? Has this been reduced or are you no longer eligible? Verification from Financial Aid shouldbe included.• Did you have student loans that you are no longer eligible for?• Has one or more parent(s)/guardian experienced a significant change and has that change resulted in a loss of income?• What has changed in your or your family’s financial situation?• Any other extenuating circumstances? How has your situation changed since you signed your housing contract?If claiming financial hardship, please take the time to break down your projected savings using the information below. Remember theburden of proof is on you, so be sure to provide all the supporting documentation you can for the information you provide.On-Campus Living- MonthlyOff-Campus Living - MonthlyRent * (Main campus double) $709.50ElectricityGas (if applicable)Cable TV ServiceInternet accessFurnishingsTransportation Costs to and fromcampus, including parking passincluded in rentincluded in rentincluded in rentincluded in rentincluded in rent$0Meal Allowance/Food **TOTAL PER MONTH* The rent charge above is based on the 2012-13 rent for a main campus double room. The $683.75 charge for a main campus doubleis divided by 4 months in the semester to arrive at an approximate monthly rent charge. If you do not live in a main campus doubleroom, use the rates below:Tribe Square / One Tribe Place Single / Jamestown Single $3568.00/4=$892.00One Tribe Place Doubles / Jamestown Doubles $3268.00/4 = $817.00Main campus singles $3138.00/4 = $784.50Main Campus Doubles/Cabell and Nicholas Apartments/Ludwell doubles and quads $2838.00/4 = $709.50Main campus triples/Ludwell triples/Double overcrowds $2738.00/4 = $684.50Main campus quads/Triple overcrowds $2688.00/4 = $672.00Grad Double Apartments $3338.00/4 = 834.50Grad Triple or Quad Apartments $3288.00/4 = 822.00** Meal Plan Information: If you are currently on a meal plan, take the cost of the meal plan and divide it by 4 to arrive at a monthlymeal allowance.

Contract Release Commuter RequestThis is to certify that I will be residing at the home of my parents, guardian or relativecommuting to William and Mary for the(term or schoolyear). I understand that if I do not reside at this address during the time stated above, my housing contract withResidence Life will be reinstated and I will be financially responsible for campus housing.Student Name Student ID #I will be residing at the following address:StreetCityState/ZipPhone NumberI certify that the information provided is true and accurate and the above named student will be residing withme at the address provided.Parent/Guardian SignatureDate