On-Campus Living Exemption Application FOR HOUSING AUGUST 23, 2019 THROUGH MAY 8, 2020 I am requesting a housing exemption for one of the following reasons: [Circle One] Residency Married student Student is a parent Designated off-campus housing Disability or medical condition Special circumstance Exemption Application For: Fall & Spring 2019-2020 Are you currently living in the UNK Residence Halls?* Yes / No Student Name NUID# First Middle Initial Spring 2020 Date: Last Date of Birth Student Cell Phone # Current Address Student Email Address Parent Email Address City State Zip Code Required for Reasons: 1, 2, 3, Student: [Signature required for all requests.] Completion of this form confirms that I am residing with my legal parent/guardian at the provided address above for the entire academic year In the event I move from my parent/guardian’s address or if my parent/guardian move from this address, I will notify the Office of Residence Life in writing immediately, so that an appropriate application to meet the new circumstances is completed If I am married or have a child, or approved to live at one of the designated off-campus housing, I understand it is not required to live with my legal parent/guardian For all reasons requested, falsification of University records is a violation of the Student Code of Conduct If it is suspected a student does not comply with their Exemption Application as submitted, the student will be referred to the Office of Student Conduct Signature of Student Date Parent or Legal Guardian: [Signature required for all requests, except married or student as a parent.] The above-mentioned student is my son/daughter/legal ward appointed by a court, who will reside with me at my principal residence at the address indicated below, or is apply for a different reason while attending the University of Nebraska at Kearney this academic year If applying for the residency reason the student will commute to classes at UNK from this address, as an occupant of my principal residence For all reasons requested, I confirm all above information is accurate Address of Parent/Guardian: Street City _ Signature of Parent or Legal Guardian State _ Printed Name of Parent or Legal Guardian Zip _ Date *If a housing contract is complete, refer to the Housing Terms and Conditions for cancellation deadlines and applicable fees that may apply Email housing@unk.edu to cancel the housing contract and provide full name, NUID, contact phone number, and reason for cancellation Approval of an Exemption Application does not negate the contract terms Refer to the On-Campus Housing Requirement Policy for additional documentation requirements Applications are not accepted until all documentation has been provided Return this completed On-Campus Living Exemption Application with accompanying documentation a minimum of two weeks prior to your New Student Enrollment day to: Office of Residence Life, 2615 11th Ave – Conrad Hall, Kearney, NE 68849 Phone: 308.865.8519 | Fax: 308.865.8714 | housing@unk.edu FOR OFFICE USE ONLY: Date Reviewed / Initials