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This form is for those residents who are in need of a rent deferment. Please complete the information below using the primary resident info (that is the resident whose name is on the rental agreement). Please keep in mind that Rent Deferments can only be submitted if you have already paid the previous month's rent.

Student ID

First Name

Last Name

Email

Select your community

Building Name/ Building Number

Apartment Number

Amount Due:

I, hereby acknowledge the indebtedness to the Regents of the University of California for UC San Diego Graduate and Family Housing rent

I understand that:

* this deferment covers one month's rent and requests for additional deferments must be submitted separately;

* I must pay the rent for one month in full on or before the 5th of the next month; the liquidated damage charge can be waived a maximum of 3 times each calendar year and will be waived only if I submit this request prior to the sixth day of the month;

* any financial aid credits to my account will automatically apply to existing housing charges in accordance with UC San Diego, Student Business fiscal policies;

* deferments do NOT cancel Autopay agreements that resident's set up themselves. To stop Autopay payments during deferment periods, please login to your account via Student Financial Solutions here;

* failure to meet the requirements of this agreement will void this agreement and permit the university to accelerate the balance due and pursue collection of this debt; a hold may be placed on my UCSD student records until the balance is paid in full and;

* I must make my check payable to: UC Regents and payments should be sent to UC San Diego, Central Cashiers office, 9500 Gilman Drive, MC 0009, La Jolla, CA 92093-0009

I agree to the above terms and conditions:

Yes I Agree