Housing Application for Graduate Students, Professional Students & Mississauga Academy of Medicine

First Name: *

Last Name: *

UofT Student Number: *

Date of Birth: *

Day

Month

Year

Gender: *

Male

Female

Transgender

Utoronto E-Mail Address:

Alternate E-Mail Address:

Phone Number: *

Alternate Phone Number:

Academic Status *

Graduate

Mississauga Academy of Medicine

Other

If academic status has been reported as other, please specify:

Which UofT Campus: *

Mississauga

St.George

Scarborough

Anticipated Date of Graduation: *

Day

Month

Year

Intended Date of Move-In: *

Day

Month

Year

Current Address:

Street: *

Apt. #: *

City: *

Province/State: *

Postal Code/Zip: *

Country: *

Other Occupants:

If you know of an additional occupant who you would be interested in sharing a unit with, please indicated their full name and student number below. Each "other" occupant will be required to fill in their OWN application and indicate you as a preference choice as well. If not, this roommate choice will not be considered. Please be reminded that all "other" occupants will be reviewed for eligibility before any roommate matching can be accommodated. We have given you up to 4 choices and they will be ranked in that order of preference.

Occupant #1 Full Name:

Occupant #1 Student Number:

Occupant #2 Full Name:

Occupant #2 Student Number:

Occupant #3 Full Name:

Occupant #3 Student Number:

Occupant #4 Full Name:

Occupant #4 Student Number:

Next Steps:

FOR GRADUATE APPLICANTS: No further steps are required at this time. You will be contacted when a room becomes available. FOR MISSISSAUGA ACADEMY OF MEDICINE APPLICANTS: 1. Please read, sign, print and send in the Mississauga Academy of Medicine Occupancy Agreement available by clicking Forms & Documents in the drop down menu. 2. A non-refundable deposit in the amount of $350 Canadian Funds, made payable to the University of Toronto, in the form of a money order or certified cheque (stamped by the bank). Personal cheques will not be accepted. Please ensure your Full Name and UofT identification number is clearly stated on the front of the payment. Please send the two items listed above directly to the following address: University of Toronto Mississauga Student Housing & Residence Life Oscar Peterson Hall, Suite 120 3359 Mississauga Road North Mississauga, Ontario L5L 1C6

Declaration:

By submitting this application online, you declare that all the information provided above is complete, correct, understand and agree that if any of the information on this application is found to be incomplete or incorrect, this application may be treated as cancelled and withdrawn.

FIPPA Statement:

"The University of Toronto respects your privacy. The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy or contact the University Freedom of Information and Protection of Privacy Office at 416-946-7303, McMurrich Building, room 201, 12 Queen's Park Crescent West, Toronto, ON, M5S 1A8."

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Housing Application for Graduate Students, Professional Students & Mississauga Academy of Medicine