Board of Regents' Residency Report Form

Student ID Number:

Name:(Last) (First) (Middle)

Phone Number:

Stout E-mail:

I am exempt to the Board of Regents' Housing Policy due to the following reason: (Check all that apply)

I will have more than 59 credits before I begin at UW-Stout.
I have completed credits, I have credits this semester.

I am married. Marriage was on (mm/dd/yyyy)

I am a veteran receiving V.A. educational benefits (may exclude reservists)

I will have been out of high school two years by tht time I start at UW-Stout.
I Graduated in (mm/yyyy)

I will be over 21 years of age. Date of birth: (mm/dd/yyyy)

I will not be attending UW-Stout for the 2015-2016 academic year or the 2015 spring semester.

By clicking below I am aware that making false statements, either orally or in writing, on a university-related matter will result in disciplinary action. I understand that if my plans change, I must notify University Housing to obtain permission for my new plans.