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MSU Home :: Waiver Request

Housing Waiver Request Form

Last Name:       First Name:       Middle:   

ID:           Earned Credits:  

Date Of Birth:            

E-Mail Address:          

Home Address:     

City:     State:         Zip:     

Commuting Address:   

City:       State:        Zip:   

Home Phone:           Cell Phone:   

Select A Waiver Request Category:      

    If this is a "special circumstance", please describe the reason for the request:



       If commuting, I understand I must live at the permanent address of my parents/guardians.

       If commuting, I understand the address of my parents/guardians must be within 50 miles of campus. *for the Fall 2014 - Spring 2015 academic year, we are accepting waivers for those within 60 miles of campus.

       If married, I understand I must submit a valid marriage certificate recognized by Kentucky.

       If single parent, I understand I must submit a birth certificate for my child/children.

       If single parent, I understand I must submit majority custody documentation for my child/children.

       If internship (etc...), I understand I must submit proper documentation from my advisor.

       If internship (etc...), I understand I must submit a copy of my official schedule.

       I understand if my request is denied and I live off-campus, I will be billed a mandatory housing fee.

       I have read Housing Waiver Request information sheet.

       I understand, and agree to, the terms in the Housing Waiver Request information sheet. 

       I certify that the information contained in this form is true and accurate.


I acknowledge that entering my MSU ID Number and MSU E-mail serves as my electronic signature:


MSU ID:       MSU E-mail:  


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MSU is an affirmative action, equal opportunity, educational institution.