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Residence Requirement Exemption

Application for an exemption from the college residency requirement for 2013-14.

First Name*

Last Name*

Home Address*

City*

State/Prov*

Zip*

Country

Daytime Phone

Email Address*

I am a first year student at Holy Cross College applying for an exemption from the requirement to live in college residence halls based on the following criteria (check all that apply).

1.  I have earned 24 or more credit hours
2.  I will be at least 21 years of age prior to the first day of class
3.  I am married
4.  I am a veteran of the Armed Services
5.  I will be living with my parents/legal guardian

(If #4 is checked, please fax Form DD-214 to Dean of Students at 574-239-8323)

(If #5 is checked, complete the following information below)

Parent/Guardian Name

Parent/Guardian Address

Parent/Guardian Phone

Parent/Guardian Email

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Security Question

Is fire hot or cold?*

Residence Requirement Exemption

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