Skip to content
View information for College of Medicine students regarding COVID-19

A picture of a gazebo in front of the apartments at one of the University Manor complexes on the Penn State College of Medicine campus in Hershey. The sun can be seen glinting against the side of the gutters along the roofs as it begins to settle in for the night.

Intent to Vacate Form

You can either fill out the interactive form below, or download the PDF version of this form and submit it to the Student Housing office,

Intent to Vacate Form




Must be no earlier than 60 days from date of submission.
New Address






You will receive a copy of this notice.

By submitting this form, I acknowledge:
  1. I fully understand that I must submit this notice 60 days prior to my intended vacate date. I also agree that the 60-day notification begins when this form is received and date-stamped by the Housing Office.
  2. I fully relinquish possession of the premises and any items I may have left behind.
  3. I am responsible for removing any and all items which belong solely to me on or prior to the vacate date above.
  4. Any items remaining in or on the premises may be discarded, destroyed or disposed of in any manner The Pennsylvania State University sees fit.
  5. I am responsible for any and all costs incurred by the Pennsylvania State University due to my failure to vacate the premises and/or to remove all my belongings on or before the vacate date listed above.
  6. I may not rescind this notice nor may I change the vacate date indicated above without the prior written approval of the Student Housing Manager.
  7. I am responsible for the full amount of rent up until my vacate date. My Security Deposit may not be applied toward payment of any rent due.
  8. My submission of this Notice does not relieve me of any liability that I may have under my present Housing Lease Agreement.

Submitting this form with your full legal name serves in lieu of a signature.

Contact Information