Prepayment Deferral Request

Name:
Email
Phone Number
Term/Year
	Please defer my housing prepayment. By submitting this prepayment waiver request, you will be eligible for a space in campus housing. Once accepted and signed by the Director of Residence Services or his/her designee, you are responsible for all obligations indicated in the Terms and Conditions for the duration of the Agreement period. Please read all documents carefully to avoid any misunderstandings. The complete Terms and Conditions are now available online, in addition to our downloadable Sourcebook (PDF).
Name (as signature)	Date:

3640 Colonel Glenn Highway - Dayton, Ohio - 45435