Decline From Housing Form

This form is for students who do not have a housing assignment for the 2014-2015 academic year and do not wish to participate in room selection or the wait list process. You are forfeiting your room selection number as well as your place on the wait list.

Please fill in all fields. If you have any questions, please feel free to email us at dcl@brandeis.edu or call us at 781-736-5060. You will receive email notification once the form is received. Fields marked with * are required. Forms with incomplete information will not be processed.

*First Name:

*Last Name:

*Brandeis Email Address:

*Sage ID #:

*Class Year:

Room Selection #:

*Permanent Address:

*Phone #:


I am hereby notifying the Department of Community Living that I decline University Housing for the 2014-2015 academic year.

I understand that this notification of decline of housing is definite. I understand if I choose to rescind this form at any time I will be placed at the bottom of the housing wait list.

I understand that if this form is submitted prior to Room Selection (before March 7, 2014), I will not be participating in Room Selection and that I forfeit my lottery number. Lottery numbers are not transferable.

I understand that by submitting this form, I cannot be pulled in at Room Selection.

I understand that by submitting this form I also decline a space on the wait list.