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Personal request form

Please submit this form if you have a personally related request you would like to bring to our attention. Requests could include (but are not limited to):

  • a roommate conflict
  • an issue in your residence community
  • feeling homesick
  • worried about your own or someone else's mental health
  • want to talk to one of our student services counsellors
  • ...much more!

We're here to help so please reach out!

If this is an emergency, please contact: 

  • Duty Don: 519-498-3929


  • UW Campus Police: 519-888-4911 ext. 22222

Information provided on this form is considered private.

Information and privacy: questions regarding the collection of information on this form can be directed to the form administrator.

Please provide as much information as you are able.