Keele Undergraduate Residence Housing Application Cancellation Form

Date Date / MM / DD YYYY
Name 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 2026-2027?
Upload Supporting Documentation here.

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:

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

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.