Residence Hall Reservation CANCELLATION

Use this form to CANCEL your Residence Hall Reservation for a hall space in Eastern Arizona College's Campus Housing. Please complete all portions of the form to ensure cancellation. By submitting this form, you agree that you will NOT be checking into a residence hall on campus and are requesting a refund of the Residence Hall Reservation Reservation $150 deposit..

Please CANCEL EAC Campus housing for:	Fall Spring      Year:
Hall Assignment:
Mark Allen North Mark Allen South Nellie Lee Residence Towers Wesley Taylor
First Name:	Middle Initial:	Last Name:
EAC ID Number:

For Deposit Refund, Please Provide: Home Mailing Address:
Home City:		State:	Zip Code::

Home Area Code and Phone Number (XXX-XXX-XXXX):

E-mail Address (Required to confirm your submission):

Confirmed E-mail Address:

To help us better serve our students, please provide reason(s) for cancellation:

Financial Aid Problems Attending/Transferring to Another School Not Attending School Starting a Job Getting Married Church Service Room/Meal Plan Cost Health Reasons Other