102.05.

10

National Central University Application Form for Dormitory Check-out

Date
Student ID
Name

Male
ARC No.
Gender Female

PHD/ Master
Phone E-mail
Identity
Undergraduate No.

Refundment
Application

Reason for
Check-out

School year
First semester Second semester

:
Dorm

Room

Suspension Withdrawal Graduate Transferred

( Dorm fee would be returned to students who
apply for leaving school reason. )

Transfer period expiring Housing out of campus

( Dorm fee wouldnt be returned to students who
Others
apply for this three reasons.)

Refund
account

Post-office

Account

number

number

(2 1)

Notice

1.

()
Please do not use others account and assure
of the validity of the account numbers. If there is any problem occurred after when post
office remits money due to wrong writing and wrong account, the applicant needs to pay
all responsibility. Please stick your copy of deposit book cover on papers back.
2. 9:00~19:00
Dormitory Check out time for daily is 9:00A.M to 7:00P.M..

Certificate

I have completed the cleaning

of public areas in the bedroom responsibility and roommate has been confirmed.

Roommate Signature
()

I, who did pay the fee of dorm for this semester now make a certificate here for I lost my
receipts, and I'm sure the top of the account is correct.
Signature of the applicant:

()

________

_________
(

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2200
Dormitory check-out procedure
: Fill Application Form for Dormitory Check-out.
: Remove all the personal belongings and clean up the
room.
: Go to the dormitory service desk and find
dorm staff to check out the room clean and equipment.
: Return the room key and access card.
: Dorm staff confirm the room,cleaning,
property and public property surrendered correct.
: Finished.
The regulation of check-out from dormitory
1.Students living in the dormitory should
immediately go through the procedure for moving out from the dormitory if they are in the
conditions as listed below
(1)The students
who have graduated, suspended, withdrawal and transferred should finish moving out from the
dormitory within five days since they lose their identity as students.
(2) Students who give up voluntarily the
right to live in the dormitory in the second semester have to apply for moving out from the
dormitory before the end of the lodging period.
(3)The students who receive the official injunction to
move out from the dormitory have to finish moving out from the dormitory within five days.

Please submit the dormitory fee receipts and you

refund account copy below