Terminate_petition - Petition to Alter/Terminate ResHall or Northwood III Contracts Print Form These forms include interactive features for your

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Unformatted text preview: Petition to Alter/Terminate ResHall or Northwood III Contracts Print Form These forms include interactive features for your convenience. UM ID#:_________________ Name:______________________________________________ (Last) (First) (M.I.) Age:________ Gender:_________ UM email address:________________________________ How long have you lived in University Housing?:____________________________________ UM Housing Address:__________________________________________________________ Permanent Address:___________________________________________________________ This request is to alter or terminate: Contract Meal Plan Term: Fall Winter Spring Summer Year______ Please check the primary reason for your petition (see below for definitions) and make sure all appropriate documentation is attached to the petition. University Withdrawal/Leave of Absence Graduation (What Term?)____________ Marriage (Date)____________________ Study Abroad/Internship (Program?)_______________ Medical/Psychological Financial Other (Explain)______________________________ Documentation: This petition will not be reviewed if the documentation provided is incomplete or otherwise deemed by the Housing Review Board as inadequate to permit a final decision. The Housing Review Board may: request further documentation, contact and consult with other Housing or University departments and staff members, including: Hall Director (HD), Financial Aid Office, University Health Service, Counseling and Psychological Services, and Services for Students with Disabilities. Your Current Contract: University Housing contracts are legally binding for the entire term of the contract unless you are no longer a registered student at the Ann Arbor campus of the University of Michigan or unless the Housing Review Board grants a petition to be released from the contract. Petition approvals are not automatic and are granted only when the Review Board determines that circumstances as explained in the petition are substantially different than at the time of original contract signing. No staff person in your residence hall or at Northwood III has the authority to release you from your contract. Review Board Decisions: You will be informed of the outcome of this petition after a decision has been made by the Housing Review Board. You are financially responsible for all room and board or apartment charges unless you have been approved and either checked out of your residence hall or Northwood III (if contract termination is approved) or your board plan is altered or terminated. All information provided in this petition is understood to be confidential and will not be shared with parents or guardians (unless you are under the age of 18) without your prior approval. Decisions regarding petitions are made at weekly board sessions. When reviewing a petition, the Board will carefully review the documentation you supply. The Board may determine there are on‐campus housing options different from your current assignment that could satisfactorily meet your stated needs; it could grant your petition; or it could decline the petition. (Signature) (Date) Please read Reasons for Contract Termination and Full/Partial Board Rebated Requests Reasons that Support Contract Termination and Full/Partial Meal Plan Adjustments Contract Termination 1. University Withdrawal or Leave of Absence Submit a copy of the withdrawal form provided by your school, college, or the Registrar. Completing the withdrawal process from your academic classes does not automatically release you from your University Housing contract and vice versa. 2. Graduation Indicate expected date of graduation. Verification must be provided by the Registrar of your school or college and you cannot be enrolled in any classes during any remaining portion of your contract. 3. Marriage Submit a copy of your marriage certificate or submit a letter from the member of the clergy or civil authority performing the marriage that includes name and wedding date. In the latter case, the marriage certificate must be submitted within 10 business days of the wedding. 4. Study Abroad or Internship Submit a copy of the confirmation of your attending Study Abroad program or receipt of an internship outside of Ann Arbor. 5. Medical or Psychological In addition to the first page of this form, submit MEDICAL/PSYCHOLOGICAL‐RELATED PETITION TO TERMINATE HOUSING CONTRACT (FORM RH‐033), completed by you and your medical/health care provider. This form asks for documentation of why you cannot live in an on‐campus residence hall or Northwood III apartment. 6. Financial Submit SUPPLEMENTARY FINANCIAL STATEMENT (FORM RH‐012), completing all sections. 7. Other Your reasons for petitioning the Housing Review Board do not fit any of the specified categories. You must submit the ADDITIONAL STATEMENT sheet as part of the documentation of your petition. You must also discuss your situation with your Hall Director or the Assistant Apartment Manager and have them provide their comments on the form before submitting your petition. Meal Plan Petitions 1. Dietary Requirements If you are requesting full or partial reduction of your meal plan due to dietary requirements you must first meet with the Residential Dining Services (RDS) Nutrition Specialist by calling 734.647.2614. This meeting will be to discuss whether or not RDS is able to meet your needs. You may need to provide written verification from your physician of any medical problems that necessitate specific dietary requirements, including severity of problem, duration of treatment, and specific diet you must follow. 2. Hospitalization Submit written verification of the dates you were hospitalized. Petition to Alter/Terminate Housing Contract – Additional Statement Name:______________________________________________________________ (Last) (First) (M.I.) Date:_______________________ UM ID#:_________________________________ Please state and explain your reasons for requesting termination of your contract. Hall Director or Assistant Apartment Manager comments are required as part of the petition. Only the Housing Review Board of the Housing Information Office is authorized to release you from your University Housing contract. Residence Hall/Apartments Comments Hall Director or Assistant Apartment Manager Comments: Signature:_______________________________________________ Date:_______________________ Campus Phone:_____________________________________ Email Address:_____________________ ...
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This note was uploaded on 04/07/2010 for the course PSYCH 123 taught by Professor 123 during the Spring '10 term at University of Michigan.

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Terminate_petition - Petition to Alter/Terminate ResHall or Northwood III Contracts Print Form These forms include interactive features for your

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