St. Norbert College
St. Norbert College
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Request for Housing Requirement Release Form

Last Name *
First Name *
ID Number *
Gender *
 Male 
 Female 
Current Residence *
Room Number
(Please include Apartment / Townhouse number if applicable.)
Current Phone Number *

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Reason for Request to be released from the Residency Requirement *
 Withdrawal from the College 
 Transfer to another College or University 
 Graduation 
 Study Abroad 
 Active Military Duty 
 Marriage 
 Medical/psychological condition* 
 Demonstrable, non-replaceable loss of support base** 
 Other*** 
*: To be reviewed for consideration, you must submit an official letter from your medical provider to the Knight Connections Desk, Todd Wehr Hall, by December 9, 2011; 4:30 PM)

**: To be reviewed for consideration you must submit official documentation outlining the change (unexpected and/or substantial) in your financial situation to the Knight Connections Desk, Todd Wehr Hall, by December 9, 2011, 4:30 PM. Releases are usually not granted for this reason unless they are extreme cases.

***: Please describe below. Also, submit detailed written statement and official documentation to the Knight Connections Desk, Todd Wehr Hall, by December 9, 2011, 4:30 PM.
If Other, please explain:
If Other, please explain:
Electronic Signature *
 By submitting this form, I am requesting to be released from the Residency Requirement. 
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Department of Residential Education and Housing

Phone: (920) 403-3360
Fax: (920) 403-3361
E-mail: housing@snc.edu


St. Norbert College • 100 Grant Street • De Pere, WI 54115-2099 • 920-337-3181