STUDENT
HOUSING
NOTICE TO
VACATE EARLY
Within Reach. Beyond Imagination.
1 888 953 1133 selkirk.ca
Reason for move out:
Within Policy
Medical Reasons (Requires copy from Medical Professional stating reasons for withdraw)
Withdrew from course; (need copy of withdraw statement from Admissions)
Room-mate issues
Other (please state reasons)
Selkirk College terminated Student Housing Agreement
Last Name: First Name: Initial:
Student ID Number: Room Number: Student Housing: Tenth Street Kekuli House
Date of Student Housing Termination (Requested move out date): Date (Conrmed by Oce):
Oce Use Only:
Calculation of refund if applicable after physical inspection.
1. Refund Amount
2. Cancellation fee of $100.00 (for all spaces cancelled) $100.00
3. Total Student Housing fees charged A: $
4. Damage to the room $
5. Cleaning fees (attach inspection form) $
6. Total Cleaning and/or Damage fees B: $
AMOUNT OF REFUND:
Date: Initial:
Kekuli House Residence
301 Frank Beinder Way
Castlegar, BC V1N 4L3
Phone: (250) 365-1227
Fax: (250) 365-1316
