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License Cancellation & Termination Request
Please select the type of request you'd like to submit:
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🛈
I am requesting to cancel my license agreement.
License Term:
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2024-2025 Academic Year
Student First Name:
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Student Last Name:
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Student ID Number:
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Which Property are you submitting this form for?
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Block C
North Commons
Quad
UVA
Email Address:
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Phone #:
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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 2024- May 2025. This form is ONLY if you are licensed for this term.
Please select the reason why you are canceling/terminating:
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🛈
I am moving off campus.
I am withdrawing from CSUSM.
I have a medical hardship and will continue attending CSUSM.
I have a financial hardship.
I am graduating.
I am in the military and am being deployed.
My admission has been rescinded due to missing transcripts.
My admission has been rescinded due to major impaction.
My admission has been rescinded due to failure to meet enrollment criteria.
My admission has been rescinded due to academic probation.
No Show - Cancelled by Management
Abandonment - Cancelled by Management
Judicial - Cancelled by Management
Other- Cancelled by Management
I was hired to be an RA or Peer Mentor
International/Exchange Student - Leaving Country
Anticipated Move-Out Date
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Personal Statement - Reason for Cancelling/Terminating:
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Upload Attachment (documentation, etc.)
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I understand that I am officially requesting to cancel/terminate my License Agreement.
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I understand that submission of this cancellation/termination request does not guarantee that I will be granted a release from my License Agreement.
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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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Please note that the last business day for 2024 is December 20th. Cancellation requests submitted beginning on December 20th will not be processed until January 2nd, 2025 at the earliest, and will be handled in chronological order upon return.