Petition Waiver Form – Residential Life

Before You Proceed

As noted in the petition requirements, you should NOT submit this form unless you have received indication from Financial Aid and/or Dining Services that you are eligible to do so and a good candidate for a successful petition. The threshold for approval is high. Incomplete petitions will not be considered. First-Year students are not eligible to participate in the petition process. If you believe you have significant need to be considered for exemption from the housing and board policy, please contact Adam Kubiak, Associate Dean of Students.

Student Information

Name *

First Last

Student ID Number *

Current Housing Assignment *

Include residence hall/house and room number. If you do not have a housing assignment, type N/A.

Email *

K College email only

Phone *

Permanent Address

Address *

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Waiver Information

I am petitioning to waive: *

Board Plan Only
Housing Only
Housing and Board Plan

Reasoning for the petition: *

Financial Hardship
Health
Residing at the Permanent Address of a Parent or Guardian

Term: *

Select all that apply

Fall Quarter
Winter Quarter
Spring Quarter

Statement of Understanding

Release of Confidential Information *

By checking the box below, you give permission for College offices or personnel (e.g. Counseling or Heath Centers, Financial Aid, Residential Life) to release pertinent confidential information to the Petition Committee in consideration of your petition.

I agree