License Cancellation & Termination Request

Please select the type of request you'd like to submit: * 🛈

License Term: *

2022-2023 Academic Year

Student First Name: *

Student Last Name: *

Student ID Number: *

Email Address: *

Phone #: *

The Student Housing License Agreement is a legally binding contract in effect for the full academic year. Any first-time freshmen who are required to live on-campus will have their housing hold replaced on their MyCSUSM accounts after their cancellation/termination is processed.

This is for the license term of August 2022- May 2023. This form is ONLY if you are licensed for this term.

Please select the reason why you are canceling/terminating: * 🛈

Anticipated Move-Out Date (no more than 30 days after form submission) * +

Personal Statement - Reason for Cancelling/Terminating:

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Upload Attachment (documentation, etc.)

*

I understand that I am officially requesting to cancel/terminate my License Agreement.

*

I understand that submission of this cancellation/termination request does not guarantee that I will be granted a release from my License Agreement.

*

I understand that if my request is not approved, I will be responsible for all remaining charges and license fees.

Student Signature *

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