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        toll free: 877-463-6622
        local: 541-684-7201
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  • Reasons Requesting Exemption

    I hearby request an exemption from the on-campus residency requirement due to the following reasons: (Please check one box and provide required documents if listed below).
    ** Student and parent must complete the Verification of Residency with Parent(s) Waiver
  • Please email any additional documentation (i.e.- doctors notes, financial statements, etc.) to the Director of Residence Life at gbrock@bushnell.edu.
  • Electronic Signatures

    I realize that the housing charge will be posted on my account if I am not granted an exemption. I also understand that knowingly making false statements and/or presenting false information to a university official is a direct violation of Bushnell's Student Handbook and disciplinary action will be taken. By signing and submitting this form, I acknowledge that I understand the on-campus housing expectation and attest that the statements and any information which I provide are true and accurate.
  • This field is for validation purposes and should be left unchanged.
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