REQUEST TO CHANGE
ROOMS IN STUDENT HOUSING
Within Reach. Beyond Imagination.
1 888 953 1133 selkirk.ca
Last Name: First Name: Initial:
Requested New oom umber: Date of Move: Date (Conrmed by Oce):
Student ID Number: Room Number: Student Housing: Tenth Street Kekuli House
Tenth Street, Student Housing
702 Tenth Street
Nelson, BC V1L
3C7
Phone: (250) 505-1393
Reason for Move (please check all that apply)
Roomate issues
Medical Reasons (Requires copy from medical Professional stating reasons for move)
Did not meet expectations
Other
If ‘Other’ please state the reasons:
All room moves must be complete within 24 hours of approval. Those taking longer than 24 hours to move will be assessed $25.00 (for each room) for each
additional night the student occupies both rooms.
Please check and complete all boxes.
Paid room move fee of $100.00 (attached Receipt copy)
Completed room inspection form (old room) per move out policy
(any cleaning or damage charges MUST BE PAID PRIOR to moving to new room).
Complete room inspection form (new room)
Bedroom door locked
Keys returned
Approving Manager Signature
Date (yy/mm/dd)
OFFICE USE ONLY
STUDENT
HOUSING
click to sign
signature
click to edit
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