UTM Special Assistance & Emergency Preparedness Form

Please submit this Special Assistance & Emergency Prepareness Form if you are a UTM resident or tenant who requires assistance in the event of an emergency (i.e. medical emergency, fire, evacuation etc.). This form can be submitted for temporary or long term special assistance requirements. Once the form has been submitted you will receive confirmation of its receipt from Student Housing & Residence Life.

If you have any questions regarding this form, please contact UTM Student Housing & Residence Life by phone (905)-828-5286 or email resdesk.utm@utoronto.ca

Student #

First Name

Last Name

Email (@mail.utoronto.ca)

Unit Number

Example: OP120A

Area of Residence

Please check this box if special assistance is required

I require special assistance

Please describe the special assistance required in an emergency - including any special equipment, medication or device:

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