Housing Application for Students with Families

First Name: *

Last Name: *

UofT Student Number: *

Date of Birth: *

Day

Month

Year

Gender: *

Female

Male

Transgender

Utoronto E-Mail Address: *

Alternate E-Mail Address:

Phone Number: *

Alternate Phone Number:

Academic Status *

Undergraduate

Graduate

Visiting Faculty or Professor

Other

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

Program & Department Advisor:

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: *

Postal Code: *

Country: *

Employment Data:

Name of Current Employer:

Employer Phone Number:

Employer E-Mail Address:

Employer Address:

Other Occupants:

Occupant #1Full Name:

Occupant #1Gender:

Female

Male

Transgendered

Occupant #1Date of Birth:

Day

Month

Year

Occupant #1Relationship to Applicant:

Occupant #2 Full Name:

Occupant #2 Gender:

Female

Male

Transgendered

Occupant #2 Date of Birth:

Day

Month

Year

Occupant #2 Relationship to Applicant::

Occupant #3 Full Name:

Occupant #3 Gender:

Female

Male

Transgendered

Occupant #3 Date of Birth:

Day

Month

Year

Occupant #3 Relationship to Applicant:

References:

Please provide name and phone number of present and/or previous landlord or suitable reference:

rezNET Internet Service:

I hereby request that the UTM Student Housing & Residence Life activate the rezNET internet service on my behalf for the unit I will be residing in for the term of my agreement/contract/lease. *

Yes

By stating yes, I acknowledge that each rezNET internet service connection I request will be an additional cost per agreement and will be required at the time the housing agreement/contract/lease is signed.

Declaration:

By submitting this form, I declare that the information provided above is complete and correct and understand and agree that: 1. this application does not constitute a guarantee of accommodation on the part of the University of Toronto Mississauga; 2. 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on this application is found to be incomplete or incorrect, this application may be treated as cancelled and withdrawn.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 Students with Families