SSF - Resident Withdrawal Form

Please fill out all sections accurately & completely.

Please be mindful of standard grammatical rules and typos.

If you type something incorrectly, it will delay the processing of this form

and possibly the refund of your deposit.


Permanent Contact Information

Date of Birth*
School Email*
Alternative/Personal Email*
Confirm Email*
Home Phone:

SSF and School Information

Reason for Withdrawal (online form)*
  • Graduating
  • Internship then Graduation
  • Internship/Study Abroad
  • Transferring Schools
  • Other Living Arrangements
  • Marriage
  • Grades
  • Dismissed/Non-Renewed
  • Withdrawing before probation review
  • Medical Leave
Were you dismissed? Yes or No. *
Are you withdrawing because you are graduating?*
  • Yes
  • No
If eligible for a refund, would you like to donate: *
  • $10 of my deposit to SSF
  • $25 of my deposit to SSF
  • $50 of my deposit to SSF
  • All of my deposit to SSF
  • None of my deposit to SSF
What degree will you be graduating with?*
College Graduation Year*
College Attended*
Did you participate as any type of SSF Leadership? Select all that apply (if any).
Are you a part of a sorority or fraternity? If yes, please state which one. If no, please type "Not Applicable."*
During your time in school, please check if you were a part of any of these programs. If not, leave this part blank.
During your stay at SSF (including summers), which houses have you lived in?*
When will be your last semester at SSF? (Spring 2019, Summer 2019 or Fall 2019)*

By submitting this Withdrawal Form...

- I do hereby withdraw (cancel) my SSF housing scholarship effective end of this semester.

- I understand that of the $250-$300 Reservation Fee I orginally paid to SSF when accepting this scholarship, only $125-$150 qualifies as a refundable security deposit per the agreement I signed.


- I understand that if I wish to return to SSF, I must re-apply.

- I understand that I must complete an online Exit Survey (via Survey Monkey) prior to moving out as part of Check-Out Procedures.

- I understand I must follow appropriate Check-Out Procedures with my HM and return my Parking Decal & Guest Pass.


- I understand I must submit my final unofficial transcript via email to my DSA within one week of grades being released as part of appropriate Check-Out Procedures.


- I understand that if I was under full-time status during my last semester at SSF without prior approval from my DSA per the handbook, I forfeit my deposit.

- I understand that, if I am eligible and do all of the above, my deposit will be returned to me. I also understand that it may take 4 to 6 weeks for it to be returned.



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