SINGLE STUDENT HOUSING
INTENT TO VACATE PETITION


Resident Information

First Name:     

Last Name:     

University ID:     

Residence Hall and Room Number:     

Please enter date of checkout (if different than the end of the semester):  

You are financially and legally obligated for an entire academic year contract (Fall and Spring Semesters, or the remaining portion thereof), whether occupied or not. By requesting to terminate this academic year contract, prior to the completion of the contract period, one of the following contract termination conditions must be met. If you reside in Housing for only part of the semester and then are released from your contract, you will be responsible for the pro-rated portion of rent and fees.


Please check the reason you have for requesting that your contract be terminated:

Marriage - A photocopy of the signed, certified marriage license needs to be submitted to Housing Services within 30 days after the marriage occurs, or you will be responsible for the full term of the contract and the security deposit will be forfeited. The marriage has to occur within the semester that you wish to vacate. You will be released from the contract no earlier than 30 days before marriage date. The $200 security deposit will be refunded if all conditions stated above are met.
Intended Marriage Date:       Transferring to Family Student Housing.

Severe Medical Condition - A USU Student Health Services physician will determine all medical withdrawals. You will be responsible for pro-rated rent and fees, based on date of checkout. Contact Housing Office for detailed information regarding what is required for medical release. The $200 security deposit will be refunded if all conditions stated above are met.

Graduation/University-Required Internship – You will need to submit written verification of graduation from the Registration Office or written verification of internship from your Dept. Head or Dean on official letterhead when this form is submitted. The $200 security deposit will be refunded if all conditions stated above are met.

Military Withdrawal – You will need to submit photocopies of military orders and academic withdrawal from Utah State University when this form is submitted. The $200 security deposit will be refunded if all conditions stated above are met.

Complete Withdrawal and Non-Registration at USU – This requires that you completely withdraw and not register for classes at USU for the remainder of the academic year. If you registers for classes at any time during the academic year, you will be responsible for the entire rental amount. The $200 security deposit will be forfeited.
Please indicate reason for withdrawal (i.e. financial, mission, attending another University, etc.)


Please answer below that that you understand that it is your responsibility to contact your Resident Assistant at least 48 hours in advance to schedule a check out appointment. Failure to properly check out with Residence Life staff will result in a $100 improper check out fee and billing for accrued rent and any additional cleaning or damage charges.
 
I understand that is it my responsibility for cleaning prior to vacating and that charges may be assessed if extra cleaning is required.  
I understand that I will be responsible for any damages or missing items at time of check outs. I also understand that I will return all housing keys (room, mail and laundry card) when I check out.  
Please Note: If you choose to cancel your Intent to Vacate petition after it is submitted, Housing does not guarantee that your original space will be available. Renewed occupancy obligates the resident to full financial and legal responsibility, with assumption of all other provisions in the Terms and Conditions.