This form is to be used for students who are currently living in Residence. Residence withdrawals will not be
granted until this form has been received. Processing may take up to 5 business days. Residence Services will
contact the student to follow up with this request. Students are advised to read and review the Termination of
Agreement by the Resident in section 10 of the accommodation agreement prior to submitting this request which
can be found at:
Cancellations, withdrawals and refunds will be granted in accordance with these policy statements.
Step 1: Personal Information
Date Anticipated date of withdrawal Student Number
Last Name First Name
Daytime phone number Room number
Step 2: Reason for withdrawal
**If you are requesting to withdraw due to a medical condition, proper documentation from your treating physician must be accompanied with
this form.
By signing this form you are indicating that you wish to terminate your residence contract and move out of
residence. By signing this form you are also indicating that you have read and understand the Accommodation
Agreement and the Termination of Agreement by the Resident section of that agreement.
Signature Date
Once completed, printed and signed, this form may be submitted to Residence Services as follows:
1. Scanned and emailed to
as a PDF document
2. Brought to the Residence Office located in Building ‘B’ of West Residence during business hours of
Monday to Friday 8:30 AM to 4:30 PM
3. Faxed to 403.440.6281
Office Use Only
Withdrawal form received _________________________(date) Received by__________________________
Student contacted _______________________________(date) RA Notified__________________________
Calculated refund _______________________________(date) HK Notified__________________________
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