RESIDENCE LIFE
2039 Kennedy Boulevard . Jersey City . New Jersey . 07305        Phone: 201-200-2338

This form should be completed by students not returning to Residence Life.

General Information
 
Name
ID No.
Permanent Address
City
State
Zip Code
*Email Address
THIS FIELD IS REQUIRED.
Residence Facility (Co-Op Hall, Vodra Hall, 2040 Apt.)
Select the appropriate choice from the list shown below.


CLASS
Select the appropriate choice from the list shown below.



GENDER
Select the appropriate choice from the list shown below.

Hours from Home
Select the appropriate choice from the list shown below.



REASON FOR LEAVING
What has influenced your decision to leave Residence Life/University?
Please check all that apply and make additional comments needed.
 
Additional Comments - as needed.
Select
Religious affiliation
Does not have my major
Noise in the residence halls
Too few campus activities (during the week)
Don't like sharing living space
Policies and regulations
Lack of helpfulness from building staff and Residence Life Office.
Financial issues
Too far from home
Too close to home
Unfriendly Faculty/Staff
Family issues
Meal plan options
Transferring: If so, where?
Wasn't able to participate on an athletic team
Hidden costs (of which you were unaware)
Poor on-campus employment options
Poor off-campus employment options
Roommate/suitemate problems
Academics (too difficult)
Academics (not difficult enough)
Campus life was not what I expected. Please elaborate.
Other reasons for leaving the Residence Life University
*DISCLAIMER
Check One.

Procedure for withdrawing from housing "after" checking into your room:
  • I have scheduled an appropriate check out date and time with my RA/RC for room assessment.
  • I have removed all of my personal belongings and have left the room in the same condition upon to check in
  • I understand that all items remaining inside the room will be considered abandoned and an inappropriate check out fee will be assessed.
  • I understand that all damages not reported upon my check in will be my responsibility.
  • I understand that withdrawing from housing after the appropriate withdrawal periods may not entitle me to any refund.

All of the above must be completed.  Thank you.

Was Residence Life what you expected it to be based on information provided to you during the admission process? Please elaborate.
Were you able to request and receive the resources and support necessary from the Office of Residence Life in order to meet your needs?
If you encounter any difficulties, please contact the ITS Web Developer at helpdesk@njcu.edu. Thank you.