South Georgia State College

Request for Exemption Form

If you are granted an exemption, any Housing refunds you may be due will be processed by the Office of Housing and Residence Life. Likewise, any Meal Plan refunds will be processed by Business Services.

Send any other required forms and documentation to:

South Georgia State College
ATTN: Greg Tanner
Dean of Students
100 West College Park Drive
Douglas, GA 31533

Phone: 912.260.4217; Fax: 912.260.4442

Students should not sign an apartment lease without first receiving exemption approval. The student assumes the risk of being charged for on-campus housing and apartment rent if the exemption is denied. Failure to supply the required supporting documentation within twenty (20) calendar days from the date of this request will automatically result in a denial of exemption.

I have read the Freshman Residency Exemption Form and understand that I am NOT automatically exempt form SGSC's residency requirement.  I understand that written notice will be received whether my request has been approved or denied.  I also understand that if I have already signed a contract and am now trying to move out of on-campus housing, this form does not release me from any amount due for the contract cancellation process clarified in the termination section of my Residence Hall Contract. 

I. Identifying Information
Fall
Spring
Maymester
Summer
2016
2017
2018
2019

* First Name

* Last Name
-
(###)
-
###

####
II. Current Status - check one response below
I have applied for Housing
I have not applied for Housing
I have not chosen a meal plan
I have already chosen a meal plan and I would like to KEEP it - regardless of the outcome of this request.
I have already chosen a meal plan but I DO NOT want to keep it if an exemption is approved.
III. Rational
I am requesting exemption from the Freshman Residency requirement based upon the following circumstances (check all that apply):
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Atkinson
Bacon
Ben Hill
Berrien
Coffee
Irwin
Jeff Davis
Telfair
Ware
Thank you your request is being processed.