Housing Cancellation Request

By initialing here I acknowledge that I have reviewed and understand Section 4 of my housing agreement (Cancellation of Agreement). I understand a cancellation penalty fee may apply to my student account based on the date of my submission of this application and according to the guidelines stated in Section 5 of my housing agreement. I also understand that if approved that I am solely responsible for these cancellation fees and agree to make proper arrangements with the Western New Mexico University Business Affairs Office to pay said fees.*

Initial Here

Name*

First NameLast Name

Date of Birth

Date

W Number*

Phone Number*

Please enter a valid phone number.

Email*

Must Be Your WNMU email

What is your classification?*

Semester of Request*

Reason for Cancelation Request

Please check all that apply. All exceptions must be verifiable. The burden of proof is with the requestor.

I should be approved under the following exception:*

I am at least 21 years of age by the first day of class.I am married and will provide my marriage certificate.I am providing support to dependents.I have 30 or more college credit hours that have been verified by WNMU’s Registrar’s Office.I am attending WNMU classes at either the Deming, Lordsburg, T or C, or Gallup campus or I am participating in a university sponsored internship outside of the Tri-County area.I am a student residing with parent or legal guardian; whose permanent address is within the four-county area (Grant, Luna, Hidalgo, or Catron counties in New Mexico).I have previously signed, or electronically confirmed, a WNMU housing agreement but am now requesting cancelation due to non-registration or I will not be attending WNMU.

By selecting a cancellation due to non-registration, I acknowledge the following:

I am not registered for any classes at WNMU for the term selected above.
A hold will be placed on my registration for classes.
If I have checked-in to my housing assignment, I must vacate my room and return all keys by the effective contract release date or I will be charged $100.00 per night.
If I decide to re-enroll in classes at any time during the term(s) listed above I must:
- Reactivate my housing application with the Housing Office.
- Sign a new Housing & Living Agreement (this assignment will be offered based on space availability).
- Only upon reactivating my housing application and accepting any offered contract will Housing Services remove the registration hold for that term.

Please explain in the text box provided below. Be as detailed as possible. *

0/1000

Upload any documents to support your request.

Student Signature*

All correspondance will be sent to your WNMU email. Please make sure you are checking it daily.

Double check that you have entered your WNMU email. You will not be able to submit this form with a different email.

STAFF ONLY NOTES