Student ID Number:
Phone Number (XXX-XXX-XXXX):
Current Hall: Current Room #:
Reason for Room Change Request:
Room Change Preferences
If you do not have a specific location on campus that you are requesting, simply state the building(s) below where you would like to move. If you are wanting to move to a new space with another resident who is also wanting to move, that resident must also fill out a room change request. You will each list each other on the roommate preference below.
By listing the ID numbers of the roommate(s) you want to live with, you are verifying that you have spoken with and been given approval by the resident(s) listed and have been provided their ID numbers as proof of their approval for you to move in to their space.
First Preference Building: First Preference Room # (leave blank if no preference):
Second Preference Building: Second Preference Room #:
Third Preference Building: Third Preference Room #:
First Roommate Preference Name: First Roommate Preference ID#:
Second Roommate Preference Name: Second Roommate Preference ID#:
Third Roommate Preference Name: Third Roommate Preference ID#:
Other Information: Please list anything additional that would assist in your room change
HI: 42° LO: 34°
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