Residents withdrawing from their residence hall before the end of the contractual period must complete this form and meet with their Residence Hall Manager prior to departing.

Residence Life Withdrawal

Students planning to move off campus as a result of withdrawing from the university will submit this form for processing.

Kentucky State University Residence Hall Contract (46-02)
During the contractual period a resident can be released from the contract only for the following
reasons:

A) Withdrawal from the University
B) Graduation
C) Dismissal from the residence hall or University
D) Marriage
Room and board charges will not be adjusted or prorated for residents withdrawing for the academic
year or moving out of the Residence Hall, if it is not done within a 48-hour period from the
official beginning date of registration, unless approved by the Director of Residence Life.

Items or personal belongings which are left in the residence hall rooms or storage areas, after the
end of the semester, will be removed or disposed of. If a written notice is submitted by a resident
to remove and store items, a storage charge (minimum of
$10.00 per day) will be assessed to the resident’s account. If the resident fails to respond to a
30-day notice in regards to removing their belongings, the personal property will be disposed of.

Proper Check-out Procedure
The resident agrees to follow the prescribed check out procedure with the Residence Hall Manager or
designated staff member before vacating the residence hall. The dismissal procedure is as follows:

A) The resident must make an appointment in advance with the Residence Hall Manager or designee to
ensure he or she will be present when the resident is ready to leave.
B) The resident is responsible for leaving his/ her room in a clean and undamaged condition.
Failure to do so will result in a dirty room and damage charge(s) being assessed to the resident’s
account.
C) The resident must return all keys (where applicable) issued by the University to the Residence
Hall Manager or designee
D) The room must be inspected by the Residence Hall Manager or designee.
E) The resident and Residence Hall Manager or designee must complete a room condition report.
Failure to complete these procedures will result in a $50 improper check out fee


For office use only:

Once the withdrawal form is reviewed signatures will be required from:

Residence Life Coordinator:

______________________________________
Associate Dean of Residence Life:

______________________________________