CSUSM Housing - 2025 Exemption Form

Full Name

First Name *

Last Name *

Student ID *

Phone Number

Phone Number *

Cell Phone Number *

Permanent Address

Street Address *

Address Line 2

City *

State / Province / Region *

Country *

Email *

Exemption Request

Please indicate your exemption status below. For complete descriptions and required documentation, visit http://www.csusm.edu/housing/futuresidents/exemptioncriteria.html.

Choose the one that best fits your reason for Requesting an Exemption. *

Attach Supporting Document

Student Certification and Signature *

By signing my name in the box below, I certify that all information provided is true and correct.

Sign Here

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Date (mm/dd/yyyy) *