Keele Undergraduate Residence Housing Application Cancellation Form

Prior to completing this form, please read the following:

APPLICATION CANCELLATION POLICY (as agreed on your submitted application)

1. Every residence application MUST be accompanied by the $150 application fee ($50 non-refundable administrative fee).
2. Pending availability, a room offer will be sent to the email address provided by the applicant in their student records.
3. The official date of the room offer will be the date that the email is sent and not the date that the email is read by the student.
4. Students will be required to pay a $500 Room Deposit to accept and hold the room space.
5. If a student wishes to cancel their application, they must do so in writing by submitting the Application Cancellation Form.
6. If an application is cancelled prior to receiving an offer, a refund of $100 will be processed.*
7. Upon moving into residence, a $100 credit out of the $150 application fee will be applied to the student’s York University student account.

Glendon Residences: Please visit the Glendon Residence Application Cancellation Form.

Summer Residence at Keele: Please contact summeres@yorku.ca.

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.
York University Student Number *
Must be 9 digits. Currently Entered: 0 digits.
Phone *
Email Address *
Which Residence did you apply for as a first choice?
Reason for Cancelling *

Select the most applicable reason based on your circumstance.
State your other reason/s here. *
Maximum of 100 characters allowed. Currently Entered: 0 characters.
Are you going to be a York University Student for Academic Term 2023-2024? *
Upload Supporting Documentation here.

Attach Files Attach Files

Please upload supporting documentation regarding your extenuating circumstance that you wish to share with us.
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

By submitting this form, I agree to the following: *
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. I understand that my eligibility for a refund will be based on the Application Cancellation Policy.
Signature *

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