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Room Change Request Form

Requesting a Room Change

If you've made every effort to work it out with your roommate, including having a discussion with your CF or CM, and you still want to change rooms — or if there's another reason you need to change rooms — you MUST fill out a Room Change Request Form BEFORE scheduling an appointment with a Campus Life staff member.

AFTER the form is submitted, you will be contacted by Campus Life to discuss your room change request. The Office of Campus Life is located on the first floor of Pioneer Hall.

First Name:
Last Name:
Gender: Male Female
Email Address:
Point Park ID No:
Current Residence Hall and Room Number:
Have you spoken to your roommate(s)
about requesting a room change?		 Yes No
What is the name of the Campus Life staff member (CF or CM) you spoke with?
List your reasons for requesting a room
change, and please be specific:
Room/residence hall where you wish to move:

Have you discussed the prospect of moving
in with the person(s) currently occupying
the room you're requesting?

 Yes No

Print a Copy for Your Records
Print a copy of this contract and questionnaire for your records before submitting the form.  Select File from the menu, choose Print Preview, and then click on the Print icon.
ALL QUESTIONS ON THIS CONTRACT AND QUESTIONNAIRE MUST BE ANSWERED.  INCOMPLETE FORMS WILL NOT BE ACCEPTED. YOU WILL BE ASKED TO RESUBMIT THIS FORM IF ANY QUESTIONS ARE LEFT UNANSWERED OR INCOMPLETE.

After the form is submitted, you will be contacted by Campus Life to discuss your room change request.