SBTS 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 1000.

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.

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SBTS Student Housing Checkout Form (2018)

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