CONTRACT RELEASE REQUEST
Fall 2020 Spring 2021
Please read this form thoroughly before submitting request (this form is for individuals who applied for the Fall 2020 &
Spring 2021 Academic Year and are requesting a release from said contract). We strongly encourage that you do
not make arrangements to live off-campus until you have received a written response from our office informing you of
any financial obligations. Contract cancellation fees are listed on the back. Please download the form, complete it, save
it onto your computer and email the the completed form back to reslife@clarion.edu
Please Print:
_________________________________
_____________________________ _____ __________________________
Last Name First Name MI ID Number
_________________________________ _____________________________ ________________________________
Current Room/Hall/Reinhard Villages Apt Cell Phone # Clarion Email Address
______________________________________________________________________ __________________________
Permanent Mailing Address City State Zip Home Phone #
2021 Spring
Current # hours enrolled ________
Semester for which release is being requested: 2020 Fall
Age _______ Current Classification:
Other Have you applied for financial aid?
Please check reason for your request:
semester premium lease (supporting documentation required)
____ Withdrew and will be no longer registered as a student at Clarion University. I understand that by signing this form, my
classes for the term indicated above will be cancelled and the Registrar’s Office notified.
____ Transferring and will no longer be a registered student at Clarion University, main campus. I understand that by signing
this form, my classes for the term indicated above will be cancelled and the Registrar’s Office notified.
____ Academic suspension
____ Transferring to Clarion online courses
____ Other: ____________________________________________________________________________________________
Please provide a separate letter and/or documentation if necessary to support request.
Signature -
Please type your name:
Date: ___________________
-CANCELLATION FEES LISTED ON BACK -
Residence Life Services
218 Becht
814-393-2352
reslife@clarion.edu
____ Graduating or participating in an education program that requires out-of-town residency and did not request a one-
Please Select One
Please select one
CANCELLATION FEES:
Once you have accepted the Housing Contract terms, completed and electronically signed the Housing Contract and paid the
$200 non-refundable application fee (if applicable), you are financially obligated for the entire 2020-2021 academic year.
Contract releases will only be granted if the student no longer attends the university due to withdrawal, academic
suspension, or approved study abroad programs.
Cancellation fees will be determined based on the date of cancellation outlined below.
Cancellation rates for the Fall 2020 semester:
Incoming freshmen or new students to Clarion that do not attend the university will not be charged a cancellation fee,
but will lose their $200 application fee.
Cancellations that occur between July 1, 2020 and the end of Fall 2020 semester drop/add period defined by
Clarion University at http://www.clarion.edu/academics/academiccalendar.html, will incur a $500 cancellation
fee minus any paid $200 2020-2021 Housing application fee (if applicable).
After the Fall 2019 semester drop/add period, the housing cancellation fee will follow the University refund
policy (http://www.clarion.edu/tuition-and-financial-aid/billing-andpayments/refunds.html) outlined below:
o 100% refund through week 1 drop period
o 80% refund through week 2
o 60% refund through week 3
o 50% refund through week 4
o 40% refund through week 5
o 0% refund after week 5
Cancellation rates for the Spring 2021 semester:
Incoming freshmen or new students to Clarion that do not attend the university will not be charged a cancellation fee,
but will lose their $200 2020-2021 Housing application fee.
Returning students and students who enter into the contract for the spring semester:
o Cancellations from week 6 of the Fall 2020 semester through December 31, 2020 will be charged $500.
o Cancellations that occur between January 1, 2021 through the end of Spring 2021 semester drop/add will
incur a $1000 cancellation fee.
o Cancellations that occur after Spring 2021 semester drop/add period defined by Clarion University at
http://www.clarion.edu/academics/academic-calendar.html will be responsible for the full spring 2020
semester housing charge.
FEES ARE ASSESSED BY DATE FORM IS RECEIVED, NOT BY SIGNATURE DATE
Please email completed forms to: reslife@clarion.edu
FOR OFFICE USE ONLY: Approved Pending Reviewer’s Initials: _______
Reviewer’s Comments: _______________________________________________________________________________
Academic Hours Completed: __________ GPA: __________ WD/Cancellation Date: __________
Initials
Date
Sent letter/email
HMS - cancelled assignment
JC/BEST Remove access
FT Transactions assessed
Added to "Room Change" sheet
Other:
Recorded in CRR Date & filed
Please initial here to acknowledge that you
read the cancellation fees: __________
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