Off Campus Housing Request Form 2018-2019

OFF CAMPUS HOUSING REQUEST FORM 2018-2019

EurekaCollege requires that all full time students live in the residence halls on campus unless approval is granted by the Director of Residence Life or the Dean of Students. Students who are granted exemptions from living on campus meet one or more of the criteria listed below. Students who feel they qualify to live off campus may apply for “commuter” status by filling out this form.

All information to be considered in review of the student’s request for off campus housing should be included with this housing request form. It is permissible and encouraged to provide an additional statement outlining more specifically a student’s request to live off campus or to provide supporting information if they do not meet one of the exemptions listed below.

Please Print

Name:______Date of Birth: ______

Home Address:______

City, State, Zip Code:______

Home Phone:______Cell Phone:______

Student Status (as of Fall 2018):

 First-time Freshman  Transfer  Readmit  Returning (currently enrolled)

Class Status (as of Fall 2018):

 Freshman  Sophomore  Junior  Senior

Reason for Off Campus Housing:

______Commute from a parent’s primary residence (within a 30 mile address-to-address distance from

Eureka College). is our official tool to compute distance using 300 E.

College Ave; Eureka, IL 61530 as the campus address.

______Commute from a parent’s primary residence (if they are an incoming freshman who just graduated

from a high school within a 30 mile radius (see our website for list of high schools in our approved radius). If this applies to you, which high school did you graduate from? ______

______Have already received a bachelor’s degree

______Entering 5th year of college with senior status

______23 years old before the semester begins

______Married and/or have dependent children living with them

______Hold a full time internship or student teaching position off campus

______Incoming transfer student who has lived independently from their parents for at least 12 months (please attach a copy of a lease and/or other documentation)

______Other special request (Please specify and attach additional information):______

______

I submit this information as an accurate and true account of my reasons for seeking off campus housing. If the College finds that the information provided above is not accurate, I understand that I may be subjected to paying full housing and board fees as well as possible disciplinary action. It is also my responsibility to notify the Office of Student Life immediately if my housing arrangements have changed. I recognize that even if I choose not to live on campus, it is nonetheless my responsibility as a student of Eureka College to follow the College’s rules and regulations as outlined in the College Catalog and EC Student Handbook.

Student’s Signature: ______Date: ______

Parent or Guardian’s Signature: ______Date: ______

(Required if the student is under 18 years of age)