First and Second Year Residency Requirement Exemption Request Form

The university requires that all first and second year students live on campus. Exemptions to this residency requirement my be requested by completing this form If you fail to complete this form completely, it will be returned to you and not submitted to the On Campus Residency Exemption Committee for review. Once the form is completed successfully it will be automatically submitted for review at the next On Campus Residency Exemption Committee meeting. Exemptions are only considered if submitted under published deadlines, are reviewed on a case-by-case basis, and are only considered if one the following criteria are existent. The On Campus Residency Exemption Committee will begin meeting on a monthly basis beginning the end of January and decisions will be released via e-mail within 48 hours of each meeting.

Residency Waiver Deadlines:

Newly incoming students: April 15, 2013

Current first-year students: January 11, 2013

Important Message for All Financial Aid Applicants:

Approval of this request may change your offer of financial assistance, due to a reduction in your annual estimated cost of attendance (eliminating costs for room and board). Most financial assistance offers are created using an estimated cost of attendance, which includes on campus room and board costs.

General Contact Information

* First Name

* Last Name

* NUID (No dashes)

* Permanent Address:

* City:

* State:

* Zip Code:

* Cell Phone Number:

* E-mail Address:

* Term to begin exemption:

Please indicate your reason for an exemption request below:

* Please Select One:

Students who have established permanent residency or living with parent(s) or guardian(s) who have established permanent residency with in 20 miles from Northeastern's Boston Campus. Please provide proof of your permanent residency or residence at the local address of your parent(s) or guardian(s) with documents such as a utility bill addressed to your parent(s) or guardian(s) at the local address.

Students who are married. Please provide a copy of the marriage certificate.

Students with children. Please provide a copy of the child’s birth certificate.

Students with disabilities who beleive they cannot be accommodated within the residence hall living environment. Residency Exemption Requests will only be considered from those students who are registered with DRC prior to submission of this form. A student’s condition must first meet the general eligibility criteria to request any accommodations as a student with an ADA recognized impairment.

Students with religious beliefs who beleive they cannot be accommodated within the residence hall living environment. Please include a statement identifying your religious affiliation and the specific belief(s) that conflict with residential life living. Additionally, a letter from a religious leader, who has a defined relationship with you relative to your faith, will be required as supporting documentation.

Students who are veterans of the armed forces who are 20 years of age or older at initial enrollment. Please include a copy of the VA Certification of Eligibility, DD214, or other documentation confirming veteran status.

* Please use the space below to add any additional information to support your exemption. Any letters or attachments used for verification must be uploaded with this official document or faxed to Housing & Residential Life at 617-373-8794. (If you fax documentation: Be sure to include your name, NUID number, and the label "Residency Exemption Request" on your fax cover sheet)

Attachments:

Attachment 1

Attachment 2

Attachment 3

Newly-admitted Freshmen must complete this form by April 15, 2013. Exemption requests will be reviewed on a case by case basis after the deadline. There may be a delay in processing as the committee no longer regularly meets after the April 15th deadline! A Residency Requirement Exemption request can only be submitted once during an academic year. All decisions will be communicated in writing via HuskyMail on a rolling basis.

I certify that all information submitted in this process-including the waiver, any supplements, and any other supporting materials-is my own work, factually true, and honestly presented, and that these documents will become the property of Northeastern University and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree should the information I have certified be false.

* Student Initials:

* Submission Date:

* Indicates Response Required