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Room Check-out/Move Notification Form

 
Contact Information
   
   
   
   

 

Old Assignment
  MM-DD-YYYY  
   
   
  ?  
 

 

Forgot the combination numbers but remember the button order?

 
     
 

A key was never issued to me.

 
 

 

Click here if you are moving to another Caltech Housing location.
Click here if you are checking out of Caltech Housing.

Additional Information
  Comments:
 
   
   
   

 

Special Instructions
 
  1. If you are leaving before the end of the academic year, you must file a contract cancellation form.

  2. Resident and all personal belongings must be removed from the room being vacated by the check-out date provided. The Housing Office and the Institute are not responsible for loss or damage to personal property left in vacated rooms.

  3. Drop off your Housing key (s) in a check-out/room move envelope with your name and address to the Housing Office within 5 days of vacating the room (Housing Office mail slot if after business hours).

  4. Student must either provide current combination number (if applicable) or set combination to 0 and indicate such.

  5. Student must provide combination number of new room (if applicable) to the Housing Office.

  6. If moving off-campus during the academic year, it is the responsibility of the student to notify the Housing Office of any changes in board program by filing a Board Program Agreement Form. This is not necessary at the end of the academic year, when the current program will be canceled on the last day of the academic year board program.

    Students moving on-campus from an off-campus property will automatically be placed on a full-board program.

  7. If you have a campus extension, then you need to file a telephone service request form.

  8. If you have fix it requests that you have not submitted previously please click here.

  9. Until the above procedures are completed, Resident will be charged for room, board and any other fees as outlined on the undergraduate student dormitory license contract.  Failure to complete the Room Check-Out/Move Notification form will result in a $50.00 fine and any other penalties and surcharges as listed on the license contract.

 
   
   
   
 

Submission
 

By submitting this form, Resident agrees to the procedures of the check-out guidelines above.

 
   
   
   
 

Caltech Department of Institute Housing
1200 E. California Blvd. 160-86
Pasadena, CA 91125

Click Here to Email Housing

main number:
maintenance:
fax: 
626.395.6176
626.395.6175
626.584.7161
       

Hours of Operation:
Monday - Friday: 8:00am - 5:00pm