Housing Exemption Application

All first-year and second-year full-time students who are under the age of 21, do not live with a parent or guardian, are not married, or do not have children are required to live on campus. If you will not be living on campus because you qualify for an exemption, you are required to submit this Housing Exemption Form.

Please complete and submit the form below to apply for on-campus housing.

Please send additional required documents (listed below) to:
Mountain State University
Attn: Cristi Richardson
Housing and Residence Life Director
PO Box 9003
Beckley WV 25802 Indicates required fields.

Housing Exemption Form

I hereby request the requirement that I live on campus in Hogan Hall at Mountain State University be waived due to the following circumstance(s).

Check one or more:

I am over the age of 21
(Please forward us a copy of your birth certificate or drivers license)

I am married (Please forward us a copy of your marriage certificate)

I am the parent/guardian caring for a dependent child
(Please forward us a copy of the child's birth certificate with your name on the certificate)

I am living at home with my parent(s) and/or legal guardian(s)
(Parent/guardian must sign and return a letter stating you reside with them at home)

I am part-time student at MSU
(Please forward a copy of your class schedule after you complete registration)

Personal Information

First Name:

Last Name:

Street Address:

City:

State:

Zip

Phone (Home):
(xxx) xxx-xxxx

Phone (Work):
(xxx) xxx-xxxx

Email Address:

Please click the Submit button only once.

Network problems may be keeping your request from being processed. If you do not receive a confirmation page in the next few seconds, please contact Kimberly Bess by phone at 800.766.6067 x 1474 or by email kbess@mountainstate.edu to verify that your application was received.

Legal Statement | ©2009 Mountain State University. All Rights Reserved. Mountain State University is authorized under federal law to enroll nonimmigrant alien students. Mountain State University is accredited by the Higher Learning Commission and a member of the North Central Association (312.263.0456, www.ncahigherlearningcommission.org).