Student Affairs Residence Life Widener University, One University Place, Chester, PA 19013-5792 t: 610-499-4390 f: 610-499-4387 www.widener.edu ROOM CHANGE FORM Please complete this
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Residence Life
Widener University, One University Place, Chester, PA 19013-5792
t: 610-499-4390 f: 610-499-4387 www.widener.edu
ROOM CHANGE FORM
Please complete this form to the best of your ability and bring it to your meeting with your Area Coordinator
RESIDENT MOVING – (resident A – “YOU”)
SIGNATURE – By signing this form, I DATE New Bldg * New Room # *
verify that I would like to move into the
building and room indicated
i.e I wish to move into the vacancy in
Resident (C)’s room *
RESIDENT A’S CURRENT ROOMATE – (resident B)
SIGNATURE – By signing this form, I verify that Resident (A) is my DATE
current roommate and who has notified me that they are intending on
moving out and they explained to me the reasons for their move
RESIDENT WITH VACANCY / ANTICIPATE VACANCY – (resident C) *
Resident (A) will be occupying the vacancy in my room
*if you don’t know where you’re moving, leave blank
OFFICE USE ONLY
Room Condition Report Completed:
Current Resident Assistant Signature Date
Room Condition Report Completed:
New Resident Assistant Signature Date