I am requesting to be released from my Housing Agreement for the Spring 2012 Semester for the following reason(s):

Note: Discontinuing results in a review of your residency status upon re-enrollment to Wake Forest University at a later date.

SPECIAL NOTE: If you are planning to continue enrollment at the Reynolda Campus and desire to move off campus, you should not enter into any off campus housing arrangements prior to being officially released, in writing, from your Housing Agreement. Petitions for release to move off campus or from dining memberships are not guaranteed. Each petition will be reviewed on an individual basis. Please attach any additional documentation necessary to support your desire to be released from your Housing and/or Dining Membership Agreement. If you are released from your Housing and/or Dining Membership Agreement, you must also apply to live off campus through the Off-Campus Housing Policy process.

All Petitions to be Released from Housing must be submitted to Residence Life and Housing, Benson 101, before noon, Monday, November 7, 2011. If a petition is approved, the student will be free from financial obligations of housing rent charges for Spring 2012. Students submitting a Petition to be Released after Monday, November 7, 2011 will be charged and held accountable for a Cancellation Fee as noted on the back of this form, even if the petition is approved.

I understand that release from my Housing Agreement does not guarantee release from my Dining Membership Agreement. I understand and will abide by all terms and conditions of the Housing and Dining Membership Agreement. I certify that the information supplied in support of my petition for release is true and correct. I understand that approved releases will be subject to verification and if found to be falsified, housing fees and/or dining fees will be reactivated and I will be referred to the judicial process. I have read, understand, and agree to abide by the terms stated on this petition.