Not Returning Form:

Not Returning Form:

If you do not plan to return for the Summer, please complete the following information:

Name * First Last
BearPass ID (M Number) *
Email *
Building *
Room Assignment *
Please select the appropriate "Not Returning" reason: If your reason does not appear below, please contact the office of Residence Life, Housing and Dining Services at 417-836-5536 or ResidenceLife@missouristate.edu *

Please select the appropriate "Not Returning" reason: If your reason does not appear below, please contact the office of Residence Life, Housing and Dining Services at 417-836-5536 or ResidenceLife@missouristate.edu Graduating in May: Ensure your Advising Notes reflect your impending graduation. Transferring to another institution: Be sure you are not enrolled in future courses to avoid being charged. Withdrawing from Missouri State University: Be sure you are not enrolled in future courses to avoid being charged. International Student returning home: Be sure you are not enrolled in future courses to avoid being charged. Study Away, Student Teaching out of Area, or Academic Internship: Please upload verification from the Study Away Office or your Academic Advisor using the "Select Files" button below. Requesting to live in a Fraternity or Sorority Chapter House: Please compete the request form below (this option only applies between Fall and Spring semesters). I am staying in my apartment.
Select Files to Upload

Attach Files Attach Files
I will be ready for a Community Assistant (CA) to do a walkthrough of my apartment to complete my Apartment Condition Report (ACR) on: / MM / DD YYYY
Fraternity and Sorority Breakage Request:

This is ONLY a request. Grades are reviewed at the end of the semester, and approvals.denials are communicated once offices re-open the first week of January. Approved breakages are subject to a $250 breakage fee and loss of the $100 housing deposit.

Required Criteria to live in Chapter House (you must meet ALL criteria to be eligible).
I have lived on campus at Missouri State for two full semesters (not including summer) --OR-- I started this semester with at least 30 post-high school credit hours (dual credit does not count) At the end of the fall semester I will have at least a 2.5 cumulative GPA AND my chapter house will have at least a 2.5 GPA --OR-- I will have at least a 2.0 cumulative GPA AND my chapter house will have at least a 2.75 GPA After fall I will have successfully completed (and passed) at least 24 credit hours
Chapter House *

If your chapter is not listed, it likely means they are not eligible for breakage. Please contact the Residence Life Office at 417-836-5536 with questions.
Departing International and Exchange Students:

If you are leaving the country after this semester and not returning to Missouri State, you may be eligible to receive a voucher for a refund of your $100 housing deposit.

1. Please come to Hammons House 104 at least one week prior to your check out to request your voucher.

2. After you check out, return to Hammons House 104 before 3:00 pm, Monday-Friday to pick up your voucher.

3. Take your voucher to the Bursar's Office (before 4:00 pm Monday-Friday) in Carrington Hall to receive cash.

You will need to complete this before Commencement.
Your signature below certifies that you understand the following:

The Housing Contract is active until May 20th, 2017 for traditional residence hall residents and until July 31st for Monroe and Sunvilla apartment residents unless above criteria for cancellation or breakage are met and approved by the housing office.

If you are withdrawing or transferring, completion of this form certifies that you are not registered for future semesters. Upon your proper check-out, you will forfeit your $100 housing deposit. If you are still registered for classes after checking out of your residence hall room, you will continue to be charged until your registration is dropped.

Students who are graduating, studying away, student teaching, or participating in an academic internship will receive a refund of the $100 housing deposit provided the appropriate documentation has been submitted.

Students requesting a Fraternity or Sorority breakage (between Fall and Spring semesters) will be notified of approval or denial by the second week of January. Approvals are subject to the $250 breakage fee and loss of the $100 housing deposit.

Students who wish to remain enrolled at Missouri State University but request a breakage of the housing contract for reasons other than those listed above must contact the Office of Residence Life, Housing and Dining Services at 417-836-5536.
Draw your signature into the box below.

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