JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Maintenance Request Form
Please complete the following form for all non-emergency maintenance issues.
In the event of an emergency call 9-1-1 or refer to this sheet
https://bit.ly/iccERcontact
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone
*
Your answer
Preferred Communication
*
Text
Email
Phone call
House
*
Arrakis
Eden
French House
Helios
House of Audre Lorde
House of Commons
New Guild
Royal
Ruth Schulze
Location of problem (i.e. kitchen, room 3, first floor annex bathroom, etc)
*
Your answer
Type of Request
*
AC / heating
Doors / locks / keys
Exterior damage
Furniture
Kitchen Appliance (stove, fridge, freezer, dish sanitizer, etc)
Light / light fixtures / fans
Pest control / rodents / bugs
Plumbing / Toilet
Power outlet / power issue
Sink / shower / tub
Wall damage
Washer / dryer
Water leak
Window
Other:
Provide a brief description of the problem
*
Your answer
What have you already done to try and resolve the issue? (It's OK if the answer is "Nothing!")
*
Your answer
Is your maintenance steward aware of the problem?
*
Yes
No
Maybe
Is it ok to enter your room if you are not home?
*
Yes
No
N/A
If you answered "No", what times during the week (M-F) are you generally at home?
Your answer
If you have an animal in your room, please include name and type (i.e. Brewster, large dog or Kat, cat)
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms