I am...
First Time Student (Domestic Student)
First Time International Student
I am requesting:
To live somewhere other than Campus Village.
To live in a single occupancy bedroom as a 1st year student based on medical or other need.
An adjustment to the dining plan based on medical, religious or dietary need.
Student Information
First Name
Last Name
CU Denver Student ID Number
Date of Birth
Address 1
Address 2
City
State
Zip
Phone
Email Address
Parent(s) or Legal Guardian(s) Information
First Name
Last Name
Address 1
Address 2
City
State
Zip
Phone
Email Address (if applicable)
Standard Exemptions to Live-In Requirement
Please select those that apply:
You are over 21 years of age
You are/will be living with a parent or guardian
You are a veteran of the armed forces
You are married or a parent with dependents
You are deemed medically excusable by the Office of Community Standards and Wellness (must be supported in writing by a doctor and with appropriate medical documentation)
All other requests will be handled on a case by case basis.
Detailed Reason for Exemption Request
I certify that all the information provided is accurate to the best of my knowledge for the Fall 2013 and Spring 2014 academic year.