EmailMe Form - 2021-22 ACC Cancellation Request Form

I am requesting to cancel my: *

Housing Application (I have NOT signed a lease yet)

Lease (I have already signed a lease)

Early lease termination is ONLY granted for withdrawal or graduation from UCI.

If you will still be a UCI student, but would like to be released from your lease agreement, you may request to go through the relet process. This is separate from the early lease termination process. Please contact the Leasing Team for instructions on how to relet your lease.

Please select EACH PROPERTY for which you are requesting a cancellation. If you applied to multiple properties, you must check each property below for each application you would like to cancel. *

Name *

First Last

Mailing / Forwarding Address (Different than your ACC address if you already live with us)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

We will use this address to send you your refund check, if applicable. If you are cancelling your lease and vacating, this address will be where a refund check for your prepaid rent (if applicable) will be sent.) Failure to give us an address will result in your refund check being sent to the property for pick-up instead. A forwarding address is not required if you are canceling an application PRIOR to signing a lease and if you do not have a deposit on file.

Apartment (current residents only)

Bed (current residents only)

Email *

Preferred Date of Moveout (only if you are already living in an ACC property)

MM / DD / YYYY

Phone *

### - ### - ####

Reason for Cancellation Request *

Application Cancellation - I do not have a signed lease.

Lease - Withdraw from UCI (must submit copy of withdrawal from WITH Registrar stamp)

Lease - Graduation from UCI (must submit proof of graduation - graduation verification from academic advisor, school, or Registrar, screenshot of commencement registration, etc.)

Upload your documentation here: (Lease cancellations only. Not required for application cancellation.)

Lease Cancellation Fee

There is an early termination fee of $400 IF your lease cancellation request is granted.

This fee does not apply to APPLICATION cancellations.

If I am canceling a LEASE and my cancellation is accepted, I authorize my property to apply my deposit (if applicable) towards my cancellation fee. If I do not have a deposit on file, I must pay this fee in full. *

I have read the above guidelines and understand them. I acknowledge that my lease is not officially cancelled until I receive a lease cancellation email from the Leasing Team. If I am canceling my application only, I understand I will be removed from the waitlist and will no longer be eligible for a housing offer unless I reapply.

Signature

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