Student Affairs Residence Life Widener University, One University Place, Chester, PA 19013-5792 t: 610-499-4390 f: 610-499-4387 www.widener.edu ROOM CHANGE FORM Please complete this form to the best of your ability and bring it to your meeting with your Area Coordinator RESIDENT MOVING – (resident A – “YOU”) Name ID # SIGNATURE – By signing this form, I verify that I would like to move into the building and room indicated i.e I wish to move into the vacancy in Resident (C)’s room * Current Bldg DATE New Bldg * Current Room # New Room # * RESIDENT A’S CURRENT ROOMATE – (resident B) Name ID # Current Bldg Current Room # SIGNATURE – By signing this form, I verify that Resident (A) is my current roommate and who has notified me that they are intending on moving out and they explained to me the reasons for their move DATE RESIDENT WITH VACANCY / ANTICIPATE VACANCY – (resident C) * Name ID # Current Bldg Current Room # SIGNATURE – By signing this form, I verify that I am aware that Resident (A) will be occupying the vacancy in my room DATE *if you don’t know where you’re moving, leave blank OFFICE USE ONLY Room Condition Report Completed: Current Resident Assistant Signature Date New Resident Assistant Signature Date Room Condition Report Completed: Key Returned: Yes Area Coordinator NO N/A DATE Approve Room Change Deny Room Change