Live-In Exemption Form

I am...

First Time Freshman (Domestic Student)

First Time International Student

Student Information

First Name

Last Name

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/will be living at home with a parent or guardian

You are a veteran of the armed forces

You are married or a parent with dependents

You are enrolled for less than 10 credit hours per semester

You are deemed medically excusable by the Office of Student Life (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 and that I plan on living with my parent/guardian for the Fall 2008 and Spring 2009 academic year.