Student Housing Checkout Form

Full Name*

Campus ID Number*

Key ID Number*

Alphanumeric code located on the back of your key (ex. ET156-3). Include a code for all returned keys. If any keys were lost, state how many keys were lost.

Email Address*

Please use your student email address.

Are you checking out of an apartment or a dormitory room?

Apartment
Dormitory

Which building/complex are you checking out of?*

Which room/apartment number are you checking out of?*

Is your room empty of all your belongings?*

Do you have a mailbox at 5th & Broadway?*

Yes
No

Mailbox Number*

Please enter a number from 100 to 800000.

Will you be living on campus next semester?*

Yes
No

Summer and Winter terms are not considered semesters.

Temporary Forwarding Address*

Street Address Address Line 2 City State ZIP Code

With the exception of half-winter stay students, all students not staying on campus for the break will need to provide a temporary forwarding address. The temporary forwarding will automatically be removed the week before the next semester.

Permanent Forwarding Address*

Unless you have ALREADY made arrangements with Fifth & Broadway to continue use of your on-campus mailbox, you may NOT enter your on-campus mailing address in the fields below. If needed, you may rent your current mailbox from Fifth & Broadway for a monthly fee. Fifth & Broadway will only forward your mail for 6 months. Please make every effort to promptly change your address with those who may need to contact you.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Forwarding Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Reason for Leaving*

Graduation
Moved for ministry opportunity (outside of the Louisville area)
For Summer/Winter Break (Applicable for Residence Halls only)
Purchased/Renting a house within the greater Louisville area
Moved to another apartment within the Louisville area
Withdrawal from School

Electronic Signature*

By typing your name, you verify that you are the resident represented above and that all answers and statements above are true.

Student Housing Checkout Form

SBTS Student Housing Checkout Form

Are you ready to become a pastor, counselor, or church leader who is Trusted for Truth?