Office of Residence Life
Living at Home or with Family over 21 years of Age 2019–20
Transfer Student
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).
Transfer students are allowed to commute if they will be living at their home residence or with immediate family over the age of 21 during the
academic year. This residence must be located in Vanderburgh, Posey, Gibson, Warrick, or Henderson counties. 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.
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 transfer students who will be living with their parent or guardian or with immediate family over the age of 21 in
Vanderburgh, Posey, Gibson, Warrick, or Henderson counties during the 2019-20 academic year. A new form must be completed
for each academic year.
Before submitting this form, both student and the parent, legal guardian, or family member over the age of 21 with whom they
will be living must appear before the notary together with a 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
Family Member Name:
Last First MI
Student ID #:
Relationship:
Parent, Legal Guardian, Family Member over 21
Local Address:
Number & Street City State Zip County
Address may not be a P.O. Box.
Student:
I verify that I will be living with my parent, legal guardian, or family member below at least five (5) days per week at our local primary
residence during the 2019-20 Academic Year. If I intend to change this arrangement, I understand that I must obtain prior approval from the
Office of Residence Life or move on-campus.
Student Signature: Date:
Parent or Family Member:
I verify that the above-mentioned student will be living with me at our local primary residence during the 2019-20 Academic Year. If s/he intends
to move change this arrangement, I understand that s/he must obtain prior approval from the Office of Residence Life or move on-campus.
Parent / Family Member Signature: Date:
Indiana State Notary:
On , 20 before me, , personally appeared
(notary)
, who proved to me, on the basis of satisfactory evidence, to be the
(family member over 21 name)
person who signed this instrument. S/He acknowledged to me that s/he executed the same in support of the statements above in relation to the living
arrangement between her/him and the indicated student:
. Witness my hand and official seal.
(student’s name)
Notary Signature:
Printed Name of Notary:
Office of Residence Life Use:
