Residence Maintenance Request

Your Information

First Name

Last Name

Phone

You must use your Nipissing University student email account (you@my.nipissingu.ca)

Residence

Suite / Townhouse and Bedroom Number

Issue / Problem

Damage Location

(Suite / House, Bedroom, Laundry Room, Third Floor Hall, etc.)

Description

(Please be specific)

Permission

Yes, I agree to allow nipissing university maintenance personnel access to my suite / townhouse / bedroom

Access to suite / townhouse / bedroom is not required for this issue

My roommates have been made aware of this request

Date / Time of Request