Closing Billing Form


    The following form is intended to give residents an opportunity to provide additional information about a charge on your Bursar bill that is labeled DAMAGE (DMG), KEY, or FINE. 


Using this form, you will be able to appeal a charge, take responsibility for the charge, or notify us about the person(s) responsible for the charge.  

Appeal: If you would like to provide additional information about a charge, you may submit an appeal in writing on the pages that follow. All appeals must be submitted by August 1, 2014. 

Taking Responsibility: If you are responsible and want to make sure no one else living in that space is charged, please accept responsibility using this form.

Notification of Responsibility: If one of your roommates is responsible for the damage or lease violation on your bill, please indicate so by providing, his/her name. NOTE: Please talk with that individual about taking responsibility. The responsible individual must accept responsibility by also completing this form.     


NOTE: If you wish to provide information about muliple charges, a separate form is needed for each item.