Housing Exemption Application

Complete and submit the form below to apply for on-campus housing exemption.

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
Housing and Residence Life Office
410 Neville Street
Beckley WV 25801

Indicates required fields.

Housing Exemption Form
I hereby request the requirement that I live on campus 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.