Housing Appeals Form

* = required field

Your Full Name:*
Your Email:*
Phone Number:*
Current Class Year:*
Room Assignment (be sure to include building name and room number):*
Room Capacity (e.g. single, double):*
Type of checkout you utilized (NOTE: Residents who utilized Express Checkout waived their rights to an appeal, unless under extreme circumstances):*
Charge you are appealing (NOTE: If you are appealing multiple charges, you will need to complete a separate form for each appeal):*
Please provide your rationale to why you are contesting this charge. This rationale should be detailed and indicate specifically why you feel you are not responsible.:*
Electronic Signature:*