Petition for Waiver of On-Campus Living Requirement

This application and your supporting documentation serve as a petition which will be reviewed by the Off-Campus Housing Board. Completed applications must be received by the due date (June 1 or December 1). Late petitions cannot be accepted. You will be notified by email of the decision of the board.

Your Information

Name
Class year
ID #
Campus box
Extension
Current house and room
Summer/winter break address
Summer/winter break phone
Email address
Petition is for Fall semester (June 1 deadline)

Spring semester (December 1 deadline)

Reason for Petition

Reason for petition

A student who is getting married/a civil union or living at home with parent(s)/legal guardian(s) can automatically receive an exemption from the on-campus housing requirement.

Students living at home must live in one of the following communities: Amherst, Chesterfield, Conway, Cummington, Easthampton, Goshen, Granby, Hadley, Hatfield, Haydenville, Holyoke, North Amherst, Northampton, Pelham, South Deerfield, South Hadley, Southampton, West Chesterfield, Westhampton, Whately or Williamsburg. These towns are within a 20 mile radius (driving) from Northampton.

Explanation

Please provide any relevant details pertaining to your application. Explain the specific situation which requires residency off campus and explain the steps you have taken to work with Dining Services, Health Services, Disability Services, Residence Life staff, etc., to resolve the situation while living on cam pus. Please explain how living off campus will eliminate/change the situation you are experiencing.

Do not to sign an apartment lease before your petition is heard.

Supporting Documentation

Please provide the following information for any individual submitting supporting documentation for your application. All documentation must be signed and dated by the person submitting the information. Medical documentation should be provided on official letterhead of the physician. All documentation must be submitted by the deadline.

Email all documentation to reslife@smith.edu.

Document 1

Title/Name
Address
Phone
Email
Relationship to Applicant

Document 2

Title/Name
Address
Phone
Email
Relationship to Applicant

Document 3

Title/Name
Address
Phone
Email
Relationship to Applicant

Statement of Understanding

Please check the following information and sign below.

I, the undersigned, understand that if I am released from the on-campus housing requirement I am responsible for all off-campus arrangements, including obtaining my own housing and meals.

I understand that this petition to live off-campus is in no way a guarantee of receiving release from the on-campus residency requirement.

I agree to abide by the decision of the Off-Campus Housing Board and I understand that the decision of the Off-Campus Housing Board is final.

I understand that, if released, any room I have reserved in Smith housing for the semester(s) I am released will immediately be assigned to another student.

I understand that I am responsible for updating my address and telephone number with the Office of the Registrar.

I have meet with Student Financial Services and understand how living off-campus may change my Smith aid or grants.

Electronic Signature