APPLYING FOR OFF-CAMPUS RESIDENCE APPROVAL
(INSTRUCTIONS)
Attached are forms for off-campus residence approval. Please review and fill out only the forms which
fit your particular needs, then follow the procedures on the attached sheet.
When you submit the application to the Student Affairs Office (Keeny Hall 305), please staple in the
following order:
application
personal letter
copy of approved Residential Life lease release (if applicable)
miscellaneous forms (if applicable)
If you email the completed application to the Student Affairs Office at studentaffairs@latech.edu,
please don’t forget to attach the above listed items if applicable before sending. Additionally, when
emailing the application, the student must use his/her Louisiana Tech Email. The Tech email address
will serve to validate the typed signature on the fillable form.
Deadline date: Two weeks (14 days) before first day of classes for the quarter for
which exemption is sought.
UPCOMING DEADLINES:
Fall 2019 August 22, 2019
Winter 2019-2020 November 19, 2019
Spring 2020 February 25, 2020
Summer 2020 May 20, 2020
Fall 2020 August 27, 2020
Regulation applies only to single, full-time students who are younger than 23 years of age and have earned less than 60 hours.
Students living with their parents must submit a notarized commuting form.
NOTE: SIGNING A LEASE AGREEMENT OR PURCHASING A HOME PRIOR TO BEING GRANTED APPROVAL DOES NOT EXEMPT STUDENT FROM HOUSING POLICY.
Procedure for Requesting Permission to Live Off Campus
If you are requesting permission to live off campus for one of the following reasons, please follow the steps listed below prior to
submitting an application. This will aid in the consideration of your request but does not guarantee exemption. Please note that prior
to applying for approval to live off campus, you must first be granted approval to cancel any on-campus lease through the
Department of Residential Life.
Special Dietary Needs
1. Have your doctor complete the medical form specifying your medical condition and special dietary needs. Schedule
an appointment to see the Director of Food Services (257-2327), then take the doctor’s information to the Food
Service Director and he/she will work with you in working out a plan that meets your nutritional needs.
2. If the Director of Food Services is not able to work out a plan suitable to meet your special dietary needs, ask
him/her to give you a written statement to that effect.
3. Submit a completed off-campus application form, statement from our Director of Food Services, and a personal
statement from you giving your reasons in detail for needing to live off campus.
With Family Members
1. Submit a statement stating who you plan to live with, how they are related to you, give their name, address, and
telephone numbers (home, work, and cell numbers). Give your reasons for needing to live with this person.
2. Submit a notarized statement from the person with whom you plan to live confirming that you will be living with
them, how long you plan to live there, and your cost of room and board.
3. Submit an off-campus application along with your statement.
Financial Reasons
1. Submit documentation of your financial hardship.
Miscellaneous
1. Submit a completed off-campus application form and a personal statement giving your reasons in detail for needing
to live off campus.
In order to assure that you receive the decision prior to 2
nd
Schedule Purge date, your application must be submitted before the deadline (which is 14 days before the
first day of classes for the quarter for which exemption is sought).
LOUISIANA TECH UNIVERSITY
Office of Student Affairs
P. O. Box 3035
Ruston, LA 71272
studentaffairs@latech.edu
318 257-2445 Fax: 318 257-2961
APPLICATION FOR OFF-CAMPUS RESIDENCE APPROVAL
Note: SIGNING A LEASE AGREEMENT OR PURCHASING A HOME PRIOR TO BEING GRANTED APPROVAL DOES NOT EXEMPT STUDENT FROM
HOUSING POLICY. This request must be completed and filed in the Office of Student Affairs at least 14 days before the first day of classes for the quarter for which exemption is sought.
Name: ______________________________________________________________________________________________
(last) (first) (middle)
Check quarter for which exemption is to begin: Summer Fall Winter Spring 20______
CWID #: ______________________ Birthdate: _____________ Email: ______________________________
Local Address: ______________________________________________ Cell Phone: _________________________
Current Dorm/Rm: __________________ Local Phone: _________________ First Qtr. at Tech: _____________________
Parents’ Name: ______________________________________________________ Home Phone: _________________
Parents’ Address: _____________________________________________________________________________________
(street or box number) (city) (state) (zip code)
Total # Sem. Hrs. EARNED (including transfer hrs.): ________ Cumulative GPA: ______ Major ________________
No. Qtrs. Lived On Campus: _________________ No. Qtrs. Lived Off Campus: __________________________
Have you previously applied/been approved to live off campus? Y N If so, when? __________________
* * * IMPORTANT: PLEASE READ BELOW * * *
Attach a signed statement giving your reasons for requesting an exemption to the On-Campus Residence Requirement. Please follow
procedure listed on attached form prior to submitting off-campus application. The undersigned certifies that all information submitted
is true and correct; the undersigned fully understands that false or misleading information will subject the student whose signature
appears below to separation from Louisiana Tech University. Exemption approval does not cancel your room reservation with the
Department of Residential Life. To cancel your room, you must cancel in person or send a letter to the Department of Residential
Life, P.O. Box 3174, Ruston, LA 71272.
Signature of Student ________________________________________ Date ______________________________________
(DO NOT TYPE/MARK BELOW THIS LINE)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Date Appl. Rec’d _______________/____ Date of Notification of Decision: _________________/____ Coded _______
____Permanent exemption; do not need to reapply. COMMENTS: _____________________________________
____Approved through _____________________ Quarter. __________________________________________________
(Note expiration date. Must reapply for future exemption.)
____Approved to live with ___________________ only. __________________________________________________
____Disapproved. May appeal to Review Committee within 5 business days. __________________________________________________
__________________________________________________
______________________________________________ __________________________________________________
Chairman, Review Committee
Action Taken by Review Committee on Appeal: ________________________________________________________________ date:__________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
Action Taken by President’s Designee on Appeal: _______________________________________________________________ date:__________________
_______________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________ 9/19
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