Notification of Housing Contract Cancellation

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Email *

Notification

If living on campus you must fill out this form. If you've contracted for housing for the upcoming academic semester you must cancel by December 1st for a refund of the housing deposit. If you've contracted for the next academic year, you must cancel before June 1st for a refund of the housing deposit. If you are submitting this form after December 1st for a move-out during/at end of the fall semester, there will be a $100 cancellation fee charged to your student account.

If you are transferring or withdrawing from Butler and not intending to return, please set up a short exit interview with the Center for Academic Success & Exploration (317-940-9308) or the Office of the Dean of Students (317-940-9470), or complete the online exit interview survey (https://www.formstack.com/forms/butler-exitinterview).

First Name *

Last Name *

Butler Student ID Number *

Nine digits only, starting with 400. Note the number listed at the bottom of a Butler ID card has 11 digits, and the last two digits should not be entered.

Butler email address *

I hereby notify Butler Residence Life that I will be vacating my on-campus housing assignment for the reason indicated: *

Please note, only those pre-approved to do so may give "Other" as their reason.

Transferring to another institution (if so, indicate where below) - please fill out the following link: https://www.formstack.com/forms/butler-exitinterview

Withdrawing from all classes at Butler University, but not transferring - please fill out the following link: https://www.formstack.com/forms/butler-exitinterview

Studying abroad or outside of the Indianapolis area as a full-time Butler student

International student leaving Butler to return home

Internship outside of the Indianapolis area (including Disney program)

Student Teaching outside of the Indianapolis area

Rotations outside of the Indianapolis area

Graduating mid-year/not returning to campus housing

Approved to commute

When do you intend to return to living on campus? *

This is a non-binding choice, and you must contact Residence Life if you wish to return. There is no guarantee of a specific housing assignment. Additional action will be required in order to receive a housing assignment for your return.

I do not presently plan to return to Butler University

Spring semester - I will contact Residence Life

Fall semester - I will contact Residence Life

Summer term - I will contact Residence Life

Unsure at this time, but if I plan to return, I will contact Residence Life

Time frame for leaving *

I am submitting this for the spring semester. I understand a) this form must be submitted by 5:00 PM on December 1 in order to have the $100 housing deposit currently on file credited to my student account, b) this intent is still necessary and valid for spring semester, even if it is submitted after December 1. My intended date of check-out is indicated below.

I am submitting this intent for a more immediate leave. My intended date of check-out is indicated below.

I am cancelling my housing contract for the upcoming academic year. I understand that I must do so before June 1 in order to receive a refund of my housing deposit.

Read all the statements below and check the boxes to indicate understanding *

I understand that if I live in a residential facility I must schedule an appointment in advance with my Resident Assistant or Apartment Community Assistant to check out of my room, return my key, and complete my room condition report.

If I live in an on-campus apartment I must completely move out, clean my space, and check-out at the Apartment Village Dawghouse. Failure to properly check out will result in an improper check-out fee of $45 being placed on my student account.

I understand that I must return all keys that were issued to me when I check out. Failure to do this will result in a replacement key charge for each key not returned. Once any new key is ordered, the key charges cannot be reversed, even if I return the key(s) later.

I understand that my $100 housing deposit will be refunded to my student account (if applicable) after all charges have been assessed, including any applicable key charges, improper check-out charges, repair costs for damage in my room, unit, hall, etc. I further understand that if the housing deposit credit results in a credit balance on my student account, I must request a refund from the Office of Student Accounts if I want the money refunded to me.

Required

Current Housing Assignment *

Current Apartment or Suite and/or Room *

Current Meal Plan *

Date of intended check-out *

Please note, if you are unsure about an exact date for an end of fall semester leave, select the last day of finals week.

YYYY

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