Office of Residence Life
Living at Home Confirmation 2019–20
Freshman or Sophomore
The University of Evansville Residency Requirement All students who attend the University of Evansville are required to live on campus for a
designated period of time as described under the University Residency Requirement Policy (see back of this form).
Students who are residents of Vanderburgh, Posey, Gibson, Warrick, and Henderson counties are allowed to commute if they will be living at their
home residence during the academic year. Requests for consideration of residences in non-contiguous counties within a reasonable distance are to be
submitted to the Director of Residence Life for review.
Students who are residents of these counties but residing at locations other than the home of their parents or legal guardians are not considered
commuters living at home. A student enrolled at the University who is living off-campus in violation of this policy will be held financially responsible for
the room and meal charges for that period and will be required to move on campus for the remainder of their time under the requirement.
This form is for students who will be living with their parent or guardian during the 2019-20 academic year. A new form must be
completed for each academic year.
Before submitting this form, both student and parent must appear before the notary together with photo ID.
The University of Evansville has campus notaries available free of charge, but any Indiana State licensed notary may be used.
This notarized form must be returned to the Office of Residence Life one day prior to the residence hall opening for the
corresponding semester to avoid non-refundable housing and meal plan charges.
Student Name:
Last First MI
Parent Name:
Last First MI
Student ID #:
Relationship:
(Mother, father, or guardian)
Home Address:
Number & Street City State Zip County
Address may not be a P.O. Box. Address must match the student’s Permanent Address on file with the University.
Student:
I verify that I will be living with my parent/legal guardian during at least five (5) days per week at their local primary residence during the
2019-20 Academic Year. If I intend to move away from my parent’s home, I understand that I must obtain prior approval from the Office of
Residence Life or move on-campus.
Student Signature: Date:
Parent / Legal Guardian:
I verify that my son/daughter will be living in my home with me at least five (5) days per week at my local primary residence during the 2019-20
Academic Year. If my son/daughter intends to move away from my home, I understand that s/he must obtain prior approval from the Office of
Residence Life or move on-campus.
Parent / Guardian Signature: Date:
Indiana State Notary:
On , 20 before me, , personally
(notary)
appeared , who proved to me, on the basis of satisfactory evidence, to be the
(parent name)
person who signed this instrument. S/He acknowledged to me that s/he executed the same in her/his authorized capacity as parent or legal guardian
of
. Witness my hand and official seal.
(student’s name)
Notary Signature:
Printed Name of Notary:
Office of Residence Life Use:
