Room Change Request Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Your Information Date: * First Name * Last Name * Class Year: * Campus Email * Phone Current Housing Assignment Building: * Room Number: * Do you have a single room? * yesno If no, please provide your roommate's name: Please briefly describe your reason for requesting a room change (use back of form if needed): * Have you gone through the mediation process with your RA? * yes no RA's name: Move Request Information (Do you have a specific request for where to move or not?) I know where I would like to move (please provide as much information as you can in this section) Building: Room Number: Is this a single room? yes no If no, please provide potential roommate's name: Have you addressed this with your potential new roommate? yes no I do not have a specific request for a new housing assignment
