AppStateESS/homestead

<div class="row">
    <div class="col-md-10">
        <h2>Remove Roommate Request for {NAME}</h2>

        {START_FORM}
        <p>
            By copying the word in the image above into the box below, you are indicating that you understand that you are <b>removing your roommate request for {NAME}</b>.  To undo this action, you will have to go through the roommate request process again.
        </p>
        <p>
            {CAPTCHA_IMAGE}<br />
            {CAPTCHA} {SUBMIT}
        </p>
        {END_FORM}
    </div>
</div>