Student Accommodation Move-Out Clearance Checklist Form

Full Name

First NameLast Name

Student ID Number

Room Number or Identifier

Move-Out Date

Date

Room Condition Checklist (select all that apply)

Are there any outstanding responsibilities?

Other (please specify below)

If you selected 'Other' or have details about outstanding responsibilities, please specify:

Have all keys (room, mailbox, etc.) been returned?

Forwarding Address for Future Correspondence

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

I confirm that all move-out procedures have been completed to the best of my knowledge.