Park University
Request for Off-Campus Living Housing Exemption Form (Valid for Academic Year; must be submitted for each Academic Year for review)
Student Information
Semester Term
(ex: Fall 2022)
Student ID#
*
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Age
Female/Male
Transfer
Completed Credits
Email
example@example.com
Certification
You must complete one of the following sections to be considered for off campus approval.
Option 1:
Living with a spouse or parent
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Relationship to Student
I certify that the above information is correct and my son/daughter or spouse will be residing at the above permanent home address which is within 50 miles of Park University. For verification of my address I have included a scan or copy of a
Parent Driver's License; or,
Home Utility Bill
Marriage license
Attach document here
Browse Files
Cancel
of
Or Attach photo of document
Parent Signature
Date
-
Month
-
Day
Year
Date
Option 2:
Age/Credits
I certify that I:
am at least 21 years old
have completed at least 58 credit hours
Signature
Date
-
Month
-
Day
Year
Date
Special Considerations:
Please include any helpful additional information regarding your request to live off campus.
Submit
For University Official Use Only
Approved
Denied
Should be Empty: