Housing Contract Exemption & Release Form
Requesting Release For Following Term(s):
[For Contract Release Requests Only - Not For Current Term]
Are You an Incoming Student
(not currently living on campus)?
Complete SECTION 1 ONLY
Are You a Current Student
(currently living on campus)?
Complete SECTION 2 ONLY
SECTION 1
Housing Exemption: New Students Only
Reason for requesting housing exemption: Check appropriate box(es)
I am 21 years of age or older Birthdate:
I am transferring from another college (after h.s.)*:
Name of College:
I am transferring from another JWU campus
I am a single parent
I am married or have a domestic partner*
I am living with an adult relative 50 miles or less
from the Charlotte Campus (as determined by
MapQuest)*
* - Requires supporting documentation (college transcripts, copy
of marriage license, signature/address of relative student is
residing with, etc). Forms without required documentation
will not be reviewed.
Signature of Adult Relative (that student is residing with, if
applicable)
Relative's Address:
City: State: Zip Code:
SECTION 2
Contract Release: Current Students Only
Please provide a typed signed letter explaining the
reason(s) for this request.
Reason for requesting contract release: Check appropriate box
Medical
Student must provide signed supporting documentation from
his/her attending physician that includes diagnosis, treatment
plan and prognosis. The attending physician must also indicate
that living on-campus would adversely affect the student's
medical condition. This documentation should be sent
directly to: The Center for Academic Support (CAS), 801 West
Trade Street, Charlotte, NC 28202. The CAS Director will evaluate
the documentation, maintain it's confidentiality and make a
recommendation to the release committee on whether the
documentation warrants a contract release. In some cases, the CAS
Director may consult with JWU medical staff for specific questions
regarding documentation. Student must submit written letter to release
committee providing support for release request under this category.
Financial
Student should speak with their JWU Financial Planning Counselor who
will provide supporting documentation to the release committee. This
documentation will include the student's current financial needs, cost of
living on-campus vs. off-campus and any other documentation deemed
necessary by the release committee to make a complete evaluation of
the student's financial status. Students must demonstrate a financial
hardship. Note: Less expensive housing off campus does not constitute
a financial hardship
Other Extenuating Circumstances
Students requesting a contract release under this category
must provide the committee with supporting documentation
from parents or others to support a student's release review.
By signing below, I hereby affirm that all information provided on this form, in my supporting documentation and any oral statements given to support my
request above are truthful and accurate to the best of my knowledge. If it is found that I have provided false information, I confirm my understanding that I may
be subject to being assessed current room and board fees and/or review by the Department of Student Conduct. I have also reviewed and accepted the terms
and conditions included with this form.
Return Form to: Department of Residential Life,
Attn: Housing Exemption & Release Committee
801 West Trade Street, Charlotte, NC 28202
www.jwu.edu/charlotte/reslife
Students are advised that exemptions/releases from housing contracts are granted only in situations involving extreme or unusual circumstances, the nature of
which would prohibit living on campus or impose a severe hardship on the student. A desire to experience off-campus living is not considered an acceptable
reason for an exemption/release request. Students are cautioned against signing legal documents for off-campus housing until receiving an official decision.
