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Cancellation Form

Please complete this Cancellation Form if you are requesting to cancel your contract and move off-campus. If you have any questions, please direct them to Thank you!

* First name * Last name
* Student Number
* Email address
* Building * Room Number
* What date are you requesting to move off campus?
Requesting to cancel: Fall 2021 Winter 2022 Fall and Winter 2021-22
Reason for Moving Off Campus (explain in text box)


The University of Regina collects information under the authority of The University of Regina Act and in accordance with the Local Authority Freedom of Information and Protection of Privacy Act and the Personal Information Protection and Electronic Documents Act for purposes of the administration of the University and its programs and services. By submitting this form, you are consenting to the University of Regina Residences using your personal information to contact you about and/or administer your cancellation request.