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Withdrawal From Housing Form

The following form is for students withdrawing from on-campus housing. Please fill in all fields. If you have any questions, please feel free to email us at reslife@brandeis.edu or call us at 781-736-5060. Please allow 1-2 business days for your bill to be updated. You will receive email notification once the form is completely processed. Fields marked with * are required. Forms with incomplete information will not be processed.

NOTE:  Withdrawing from housing does not "automatically" withdraw you from your meal plan.  You must contact the Campus Card Office in Kutz Hall if you want to be removed from your meal plan.  Refunds will be based on the date your meal plan is removed.  Otherwise, you may continue to use your meal plan and the charges will remain on your account.  Contact the office with any questions -  x6-4230.



*First Name: *Last Name:

*Brandeis Email Address:

*Sage ID #:

Current Housing Assginment:
* Quad: Building (if applicable): *Room #:

*Address you can be reached after withdrawal:

*Phone you can be reached after withdrawal:

*I plan to withdraw from university housing effective the following date: (Last day you will be living in on-campus housing)

*The reason for my withdrawal is:

Study Abroad

Move Off-Campus

Leave of Absence

Transfer

Withdrawal From University

Other (please specify)

I understand that this notification of withdrawal from housing is definite. I understand that I will be charged for the entire semester if I am withdrawing mid-semester or after the end of semester deadline.

I agree to remove all personal possessions from my room 24 hours after I submit this withdrawal form or in case of withdrawing for second semester, 24 hours after my last final exam. Failure to do so will result in a $100 administrative fee.

I understand it is my responsibility to notify my suitemates and roommates regarding my withdrawal from housing.