[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 186.24, "t": 718.8, "r": 462.24, "b": 685.44 }, "text": "Office of Residence Life\nUniversity Housing Exemption Request Form", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 69.36, "t": 673.2, "r": 526.32, "b": 605.52 }, "text": "Per University policy, all full-time freshmen and sophomore students of Kentucky State University are required to live in University housing excluding the four designated exceptions (listed below). NOTE: Exceptions must be met before the first day of classes AND requested before signing a Two-Semester Residence Hall contract. Students who are currently in a residence hall contract agreement will not be granted a requested exception during the contracted period.", "reading_order": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 236.64, "t": 605.04, "r": 374.16, "b": 592.08 }, "text": "Please print and write legibly.", "reading_order": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 70.56, "t": 580.56, "r": 533.76, "b": 543.12 }, "text": "Student’s Name: ___ SID#: ___", "reading_order": 3 }, { "page": 1, "type": "TEXT", "location": { "l": 71.28, "t": 547.2, "r": 532.56, "b": 507 }, "text": "Street Address Apt/Suite #", "reading_order": 4 }, { "page": 1, "type": "TEXT", "location": { "l": 71.28, "t": 507, "r": 532.56, "b": 466.8 }, "text": "City State Zip Code", "reading_order": 5 }, { "page": 1, "type": "TEXT", "location": { "l": 105.36, "t": 465.6, "r": 468.96, "b": 452.16 }, "text": "Primary Telephone Number KSU E-mail Address", "reading_order": 6 }, { "page": 1, "type": "TEXT", "location": { "l": 145.44, "t": 441.84, "r": 465.6, "b": 428.64 }, "text": "Below, please mark an \"X\" in the box next to the appropriate exception.", "reading_order": 7 }, { "page": 1, "type": "TEXT", "location": { "l": 71.28, "t": 428.88, "r": 233.36, "b": 393.216 }, "text": "Select One", "reading_order": 8 }, { "page": 1, "type": "TEXT", "location": { "l": 233.36, "t": 428.88, "r": 395.44, "b": 393.216 }, "text": "Exception - I am a student who", "reading_order": 9 }, { "page": 1, "type": "TEXT", "location": { "l": 395.44, "t": 428.88, "r": 557.52, "b": 393.216 }, "text": "Required Documents/Information", "reading_order": 10 }, { "page": 1, "type": "TEXT", "location": { "l": 233.36, "t": 393.216, "r": 395.44, "b": 357.552 }, "text": "Is at least 21 years of age", "reading_order": 11 }, { "page": 1, "type": "TEXT", "location": { "l": 395.44, "t": 393.216, "r": 557.52, "b": 357.552 }, "text": "Birth Certificate, valid Driver's License or government issued Photo ID", "reading_order": 12 }, { "page": 1, "type": "TEXT", "location": { "l": 395.44, "t": 357.552, "r": 557.52, "b": 321.888 }, "text": "Notarized Parent/Legal Guardian Address Verification Form AND clear copy of parent/legal guardian's valid Driver's License or government issued Photo ID", "reading_order": 13 }, { "page": 1, "type": "TEXT", "location": { "l": 395.44, "t": 321.888, "r": 557.52, "b": 286.224 }, "text": "Marriage License/Certificate", "reading_order": 14 }, { "page": 1, "type": "TEXT", "location": { "l": 395.44, "t": 286.224, "r": 557.52, "b": 250.56 }, "text": "Military DD214", "reading_order": 15 }, { "page": 1, "type": "TEXT", "location": { "l": 233.36, "t": 357.552, "r": 395.44, "b": 321.888 }, "text": "Commutes 50 miles or less from the principal residency of a parent or legal guardian", "reading_order": 16 }, { "page": 1, "type": "TEXT", "location": { "l": 233.36, "t": 321.888, "r": 395.44, "b": 286.224 }, "text": "Is married", "reading_order": 17 }, { "page": 1, "type": "TEXT", "location": { "l": 233.36, "t": 286.224, "r": 395.44, "b": 250.56 }, "text": "Is a veteran of at least two years of active military service", "reading_order": 18 }, { "page": 1, "type": "TEXT", "location": { "l": 68.88, "t": 240.24, "r": 537.84, "b": 171.84 }, "text": "All supporting documentation must be submitted to the Office of Residence Life before the first day of classes. Forms submitted without the required documentation will be automatically denied. Any requests submitted and approved after the first day of classes will have charges assessed per the University’s Tuition and Fee Refund Schedule. Students will receive the decision notification via e-mail to their KSU e-mail address; students may submit a written appeal to the Residence Life Appeals Committee.", "reading_order": 19 }, { "page": 1, "type": "TEXT", "location": { "l": 69.12, "t": 162.48, "r": 515.52, "b": 121.2 }, "text": "By signing below, I certify that accurate information is enclosed on this form and on the supporting documents. In addition, I understand submitting false information may result in disciplinary actions including but not limited to restitution from the University and/or other actions.", "reading_order": 20 }, { "page": 1, "type": "TEXT", "location": { "l": 68.88, "t": 109.2, "r": 385.68, "b": 96 }, "text": "Student's Signature: _____\nDate: _____", "reading_order": 21 }, { "page": 1, "type": "TEXT", "location": { "l": 398.16, "t": 108.24, "r": 533.76, "b": 96 }, "text": "Date:", "reading_order": 22 } ] }, { "page": 2, "items": [ { "page": 2, "type": "TITLE", "location": { "l": 254.4, "t": 704.4, "r": 357.36, "b": 690.72 }, "text": "For Office Use Only", "reading_order": 0, "level": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 70.08, "t": 679.68, "r": 541.2, "b": 664.8 }, "text": "Date Documentation Submitted: ___ Received by: ___", "reading_order": 1 }, { "page": 2, "type": "TEXT", "location": { "l": 69.6, "t": 659.52, "r": 540.72, "b": 643.68 }, "text": "Request Decision: ___ Amount of Charges Accessed: $___", "reading_order": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 70.32, "t": 638.64, "r": 539.52, "b": 622.56 }, "text": "Dir. of Res. Life's Signature: ___ Date: ___", "reading_order": 3 }, { "page": 2, "type": "TEXT", "location": { "l": 70.08, "t": 617.52, "r": 539.28, "b": 602.64 }, "text": "Date Decision E-mail Sent: ___", "reading_order": 4 }, { "page": 2, "type": "TITLE", "location": { "l": 265.44, "t": 575.52, "r": 346.08, "b": 560.64 }, "text": "Appeal Process", "reading_order": 5, "level": 2 }, { "page": 2, "type": "TEXT", "location": { "l": 68.88, "t": 555.12, "r": 535.92, "b": 539.28 }, "text": "Date Appeal Received: ___ Date Forwarded to Committee: ___", "reading_order": 6 }, { "page": 2, "type": "TEXT", "location": { "l": 69.36, "t": 534.72, "r": 534.72, "b": 518.16 }, "text": "Committee's Meeting Date: ___ Committee's Appeal Decision: ___", "reading_order": 7 }, { "page": 2, "type": "TEXT", "location": { "l": 69.12, "t": 513.6, "r": 535.2, "b": 497.52 }, "text": "Date Decision E-mail Sent: ___ Date Banner System Updated: ___", "reading_order": 8 } ] } ]