Academy of Art University - Department of Housing



The Housing License Agreement (HLA) is a full academic year agreement (August to May). Submission of this form does not automatically release you from this agreement. You will be notified via email on Friday, December 6, 2013, whether or not your petition has been approved. If approved, you may be asked to submit supporting documentation. Failure to get approval or submit supporting documentation will result in you being responsible for Spring 2014 RENT -- NO EXCEPTIONS.

In order for your petition to be successfully submitted, you will need to complete this form in full.

DEADLINE : 5:00 PM on December 3rd, 2013

* Required

ID Number: *

Enter your AAU student ID number

First Name: *

Last Name: *

Personal Contact Phone Number: *

This should be a working number you can be reached at. Not a friend or family member's telephone number.

Email Address: *

Current Assignment: *

Please select your building from the drop down menu.

Room Number: *

Please include your room number and assigned bed space (if you know your bed space). (ex. 303-a, 303A-c etc...)

Check the category that most appropriately reflects your reason for requesting consideration for release from your HLA. *

University withdrawal
Graduation (Fall 2013 ONLY)
Medical or extenuating financial circumstance(s)

Reason for request: *

It is required that a recent change in circumstances has occurred which makes you unable to honor your Housing License Agreement (HLA). Please include a reason (or reasons) in the field below explaining, in detail, why you should be released from your Housing License Agreement. Petitions will not be accepted without supporting documentation. Examples of supporting documents include - doctor's note, proof of financial hardship, etc.

Petition Terms -

In order for your petition to be successfully submitted, you will need to complete this form in full. Please fill in the below information.

I understand the Housing License Agreement (HLA) is a binding document, and by signing it, I committed myself to housing for the Fall 2013/Spring 2014 academic year. By petitioning for release, I understand I am breaking the agreement I entered into with the Academy of Art University *

I Agree

I understand that IF I am granted a release from the Housing License Agreement I will NOT be eligible to reside in Campus Housing during Winter Intersession. I understand I MUST vacate my Fall 2013 housing assignment no later than 12:00 pm on Saturday, December 21st, 2013. *

I Agree

I understand I will forfeit the remainder of my $500 housing deposit if released from the terms of the Housing License Agreement. *

I Agree

I understand I will receive an email (at the address included on this form) on Friday, December 6, 2013 either approving or denying my Petition for Release request *

I Agree

REMINDER: Completion and submission of this Petition for Release from Housing form DOES NOT automatically release you from your HLA. DO NOT make any other arrangements or sign an off-campus lease until you receive written confirmation granting your release. You will be notified via email of the status of your request. If your request is denied and you decided to move out of the residence hall/apartment, charges will continue to be added to your bill for the remainder of the academic year. Should a release be granted, you will forfeit the remainder of your $500 security deposit and will not be able to reapply for housing for the Spring 2014 semester.

By signing below, I am officially indicating my understanding of the statements above and requesting release from my Housing License Agreement. I also attest that the information I have provided in this petition request is accurate and complete to the best of my knowledge. Additionally, I understand that this is only a request and that I may or may not be approved.

Student Signature (Electronic): *

Date: *

Please submit in the following format MM/DD/YYYY