York Apartments Resident Concern Form

Date * / MM / DD YYYY
Name * First Last
Please enter your name exactly as it appears on your YU-card. Please do not enter any nicknames or names that are not on file with the Registrar's Office.
I am a: *

I am a: Leaseholder Registered sharer
If you are a York University student, please provide your student number below:
Must be 9 digits. Currently Entered: 0 digits.
York Apartments Building *
Unit Number *
Maximum of 20 words allowed. Currently Entered: 0 words.
Phone *
Email Address *
Is your concern regarding a resident or a staff member? *

Is your concern regarding a resident or a staff member? Resident Staff Member
Please provide as much detail as possible including name, unit number/s (where applicable) and approximate time/date of occurrence) about your concern/s below: *
Maximum of 500 words allowed. Currently Entered: 0 words.
You may upload a file or photo here related to your concern:

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Privacy: Personal information in connection with this form is collected under the authority of The York University Act, 1965 and will be used for the administration of residence services including repairs, maintenance and other related or consistent purposes. Relevant information and emergency contact information will be shared with residence and other University staff for emergency management purposes. If you have any questions about the collection, use or disclosure of personal information by York University, please contact Housing & Conference Services at apstatus@yorku.ca.
Declaration and Consent *
I confirm that I am the leaseholder/registered sharer of the above indicated apartment unit. Pursuant to the Freedom of Information and Protection of Privacy Act, I give my consent to York University to use and disclose my personal information as noted above.
Leaseholder/Registered Sharer Signature *

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