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Student Organizations Intramurals Student Conduct Student Conduct Student Conduct FAQs Campus and Community Expectations Tobacco Free Incident Report Form Everfi Training Current Students Residence Life & Housing Request for Exemption Form Request for Exemption Form Please fill in all required fields to continue. If you are granted an exemption, any Housing refunds you may be due will be processed by the Office of Housing and Residence Life. Likewise, any Meal Plan refunds will be processed by Business Services. Send any other required forms and documentation to: South Georgia State College ATTN: Greg Tanner Dean of Students 100 West College Park Drive Douglas, GA 31533 Phone: 912.260.4217; Fax: 912.260.4442 Students should not sign an apartment lease without first receiving exemption approval. The student assumes the risk of being charged for on-campus housing and apartment rent if the exemption is denied. Failure to supply the required supporting documentation within twenty (20) calendar days from the date of this request will automatically result in a denial of exemption. I have read the Freshman Residency Exemption Form and understand that I am NOT automatically exempt form SGSC's residency requirement. I understand that written notice will be received whether my request has been approved or denied. I also understand that if I have already signed a contract and am now trying to move out of on-campus housing, this form does not release me from any amount due for the contract cancellation process clarified in the termination section of my Residence Hall Contract. I. Identifying Information * This request is for what term: Fall Spring Maymester Summer * What year? 2016 2017 2018 2019 * Full Name: * First Name FULL NAME: is required. * Last Name FULL NAME: is required. * Student ID or 988#: STUDENT ID OR 988#: is required. * Phone Number: - (###) - ### #### PHONE NUMBER: is required. * Active Email Address: ACTIVE EMAIL ADDRESS: is required. II. Current Status - check one response below * Housing check one: I have applied for Housing I have not applied for Housing Meal Plan: Option 1 I have not chosen a meal plan Meal Plan: Option 2 I have already chosen a meal plan and I would like to KEEP it - regardless of the outcome of this request. Meal Plan: Option 3 I have already chosen a meal plan but I DO NOT want to keep it if an exemption is approved. III. Rational I am requesting exemption from the Freshman Residency requirement based upon the following circumstances (check all that apply): 21 years of age by the 1st day of the fall semester Yes No Married (must attach a copy of the marriage license) Yes No Caring for a dependent child (must attaach a copy of the birth certificate) Yes No Veteran with at least a year of active service (must attach a copy of discharge documents) Yes No 30 or more earned credit hours (not including advanced placement) Yes No Move On When Ready Yes No Enrolled in fewer than 11 credit hours Yes No Medical conditions for which the College cannot achive reasonalbe accommodations (condition must be on file with the Office of Student Disability) Yes No Waiver based on extreme hardship (case by case decision) Yes No Claims residency in the following counties: Atkinson, Bacon, Ben Hill, Berrien, Coffee, Irwin, Jeff Davis, Telfair, or Ware (must attach a copy of your driver's license) Atkinson Bacon Ben Hill Berrien Coffee Irwin Jeff Davis Telfair Ware Thank you your request is being processed. * Please enter the letters above into the field below. 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