HOUSING AND RESIDENCE LIFE
FIRST TIME FRESHMAN RELEASE REQUEST TO COMMUTE
(Use for students not withdrawing from university,
seeking to reside off campus and does not currently live on campus.)
I, , verify that my son/daughter
PRINT PARENT/GUARDIAN’S NAME
,
PRINT STUDENT’S NAME RAM ID#
will be residing with a parent or guardian address, in the following counties Dougherty, Worth, Mitchell,
Baker, Calhoun, Lee and Terrell. I understand that violation of this agreement will result in my son/
daughter being required to move back on campus, pay the room and board portion of the contract or both.
Parent or guardian’s name,
whom you will be living with: _____________________________________________________________
Street Address:
City and State _________________________________________________________________________
Parent’s Address
(if different from above)
Name of County in Service Area:
This document must be accompanied by a copy of the Student’s driver’s license.
Parent and student signature is required.
Parent/Legal Guardian Signature Date:
Student Signature Date:
Housing Official Only (below)
Received By: _____________________________________________ Date: ________________________
