Housing Deposit Waiver Request

Request to Waive Residence Life Security Deposit

Residence Life Housing Security Deposit Waiver Request Form

If the housing deposit presents a significant burden and will be a barrier to your enrollment at SUNY Adirondack, please complete this form to request a waiver of this requirement. If your request is approved, you will be required to complete a Residence Hall Damage Agreement form.

First Name*

Last Name*

Banner ID*

Email Address*

Phone Number*

Mailing Address*

Country

Street

City

Region

Postal Code

I understand that by requesting and being granted a waiver of the $250 security deposit required for
students seeking to reside in Residence Life at SUNY Adirondack that I am solely financial responsible for
any and all damage to the suite that I am assigned in the SUNY Adirondack Residence Hall. By being
granted a waiver of the $250 security deposit, I authorize Residence Life staff to inspect my room at any
time to evaluate condition and cleanliness. If at any time, the room is deemed deficient and requiring a
damage fine, I understand the fine will be assessed to my student account, and a registration hold will
be placed on my account.

Student Signature