___________Frostburg State University Residence Life Office___________
101 Braddock Road, Frostburg, MD 21532 Ph: 301/687-4121 Fax: 301/687-7641
Request for Release from Housing Contract
When you completed the on-line Housing Application form, you agreed to fulfill all terms and
conditions of the Housing Contract for the entire academic year. Completion of this form does not
guarantee release from the Housing Contract. Requests are reviewed and decided upon by the Director
of Residence Life or their designee.
Students graduating or withdrawing from the University at the end of the 1st semester need not apply for release;
however, they are still required to follow appropriate check-out procedures before moving out of their hall.
PLEASE COMPLETE THE FOLLOWING – Print Clearly
Student Name: ___________________________________________________
Last
First
Current Hall: ___________________________ Room #: ________________
Current Class Standing:
FSU ID #: ______________________
MI
Cell Phone #: ___________________
 Freshman  Sophomore  Junior  Senior  Graduate Student
CONDITIONS FOR REVIEW
When submitted, your request must include detailed official documentation supporting the release claim. Only completed
requests with all required documentation will be reviewed. Any release request submitted without documentation will not be
reviewed.
DOCUMENTATION
To make the most informed decision and proved an appropriate response, students are asked to provide a complete set of
documents supporting their request. The documentation must validate that:
1. A situation has arisen since the Housing Contract was filled out and submitted.
2. The situation is beyond your control.
3. All other resources have been exhausted in the pursuit to rectify this situation.
4. The only viable option left is to leave the Residence Halls and cancel your Housing Contract.
Please check the category below that most appropriately reflects your reason for requesting to be released from your housing
contract. (Any and all documentation you wish to have reviewed must accompany this form.)
 Financial – Attach documentation demonstrating an inability to meet your financial obligations to FSU.
EXAMPLES:
 Official documentation indicating unexpected expense increases (no ATM bank statements) or financial hardships
(tax records or W2 forms).
 Letter from employer(s) verifying loss of employment or loss of income for either parent or student.
 Financial Aid letters or bank letters demonstrating denial of aid or loans.
 Medical – Attach documentation from a physician stating why the continuation of an on-campus residence is detrimental
to your physical health. (A University physician may be consulted in some cases.)
EXAMPLES:
 Letters from accredited personal physicians, therapists or other medical professionals indicating your condition; how
long you have been in treatment for this issue; why this would preclude you from living in a college residence hall
facility, etc.
 Psychological – Attach documentation of an established relationship with a certified professional counselor who can
verify that your needs cannot be met in an on-campus living environment.
 Internship – An Internship must be for FSU credit and be at a distance that would prohibit continued living in an oncampus residence hall. Students are responsible for ensuring that any needed verification is submitted to the Residence
Life Office by the appropriate University department.
 Study Abroad Opportunity – Must be with an approved, University sponsored program. Student must provide
documentation from the Center for International Education verifying the semester(s) that the student will be away.
REMINDER: Submitting reviewable material and the completion of this form DOES NOT
guarantee a release from your Housing Contract.
(Continued on reverse)
___________Frostburg State University Residence Life Office___________
101 Braddock Road, Frostburg, MD 21532 Ph: 301/687-4121 Fax: 301/687-7641
Request for Release from Housing Contract (cont.)
IF YOUR RELEASE IS APPROVED:
 An email will be sent to your Frostburg State University email indicating that your request has
been granted. If your request for an immediate release has been approved, you must vacate your
residence hall room and have been checked out by your Resident Assistant within seven (7) days
of your request being granted. If a release request is for the upcoming semester, residents must
complete the check out process with Residence Life Staff before the start of the semester break.
Failure to check out properly will result in charges being added to your account.
 Refunds will be based upon the policies of the Billing Office. Any refund given will be
determined by the prorated number of weeks remaining in the semester, if applicable.
 If released from your on-campus housing assignment, your meal plan is automatically cancelled.
If you wish to continue to utilize a meal plan during the academic year you must contact the
Billing Office (301-687-4321) to sign up for a new meal plan.
IF YOUR REQUEST IS DENIED:
 An email will be sent to your Frostburg State University email indicating the reason your request
was denied.
 You will continue to be responsible for all housing charges and obligations as defined by the
Housing Contract.
FOLLOW-UP
1. Has all required supporting information and documentation been submitted with this
request?
 Yes, all supporting information and documentation have been submitted.
 No, additional material will be submitted to the Residence Life Office by: ______________.
DATE
By signing below I am officially requesting release from my Housing Contract. I attest that the
information I have provided in this request is accurate and complete to the best of my knowledge. I
understand that submitting this form does NOT constitute approval of my request and that I will be
notified by the Residence Life Office via email once a decision has been made. If my request is denied, I
understand that I will be responsible for any and all semester housing and dining charges.
(Students who leave University housing but then wish to return must submit a Housing Application
and have their name placed on a waitlist. There is no guarantee that on-campus housing will be
available.)
STUDENT SIGNATURE: _____________________________________________ _____
OFFICE USE ONLY
REQUEST WAS:
DATE: __________________
DATE REQUEST RECEIVED: _________________________________
______ APPROVED
REASON FOR DECISION:
or
______ DENIED