Residency Requirement Form

All Lourdes University Students are required to live on campus for eight semesters unless the student meets one of the following exceptions:
Choose one or more of the following:*
- Lives with a parent or guardian within 35 miles of campus. Please visit www.lourdes.edu/housing and click on the residency requirement for a list of zip codes which fall within 35 miles of Lourdes University
- Has reached the age of 23 prior to the beginning of the fall semester
- Is married or has a child
- Is serving or has served in the U.S. Armed Services
- Has received an exemption from the Office of Accessibility Services based upon an accessibility issue
If one or more of the above exceptions applies to you, please check the appropriate box and sign below. If you do not meet one of the above exceptions you will be required to live at Lourdes University in on-campus housing. If living with a parent or guardian within 35 miles of Lourdes University, please list current address below.
Street*
City*
State*
Zip*
By including your signatures below and pressing submit you are agreeing that the information within this form is correct.
Student Full name*
Parent Full name*
Date*
MM slash DD slash YYYY