Residency Exemption Form

All students classified as a freshman and under the age of 21 for the current academic term, who decide not to reside on-campus must complete and return this form to the Office of Housing/Residence Life and Dining Services before the first day of classes. This form must be completed every year until the student no longer meets the stated criteria. Students who do not return the Residency Exemption Form will be assigned to University housing until the University receives confirmation that the student is living with a parent/legal guardian or is otherwise exempt. Charges for housing and meal plans may be applied to the student’s account until confirmation of residency is received.

Once the freshman residency form is completed and turned into the housing office, your request will be approved unless you receive an email to your APSU student account indicating you have been denied an exemption.

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Student Name*(Last, First)

Academic Year/Term*

Name of Parent(s)/Guardian(s)*

Street Address*

City*

State*

Zip Code*

Exceptions to Residency Requirements*

Students who are 21 years or older

Students who have a spouse or dependents living with them

Students who will be living with parent(s) within a fifty miles radius to APSU

Electronic Signature

I affirm

By checking the "I affirm" box, I affirm that all of the information provided on this form is accurate and that I am the authorized owner of the indicated student ID (A#). I certify I will be living with a parent(s) or legal guardian at the above address and commuting within a fifty mile radius to Austin Peay State University for the current academic year. I understand that if I do not meet one of the exceptions below or no longer live with a parent or legal guardian I must make arrangements for on campus housing. I am aware that if I fail to notify the Office of Housing/Residence Life and Dining Services of a change in residency, I will be assigned and billed for housing and a meal plan for the duration of time I do not meet the residency exception requirements. Finally, I understand that I may also be subject to University discipline charges through the Student Code of Conduct if in violation of these terms.

Contact Us
Office:	Housing/Residence Life & Dining Services
Location:	Miller Hall, Room 121
Phone:	(931) 221-7444
Fax:	(931) 221-7165
Email:	housing@apsu.edu