housing maintenance REQUEST FORM

All non-emergency requests for maintenance in the residence halls should be submitted with the form below. If it is an emergency, please go to the front desk and submit a maintenance report.

Fields marked with an asterisk (*) are required.

First Name

Last Name

Date of Request

UAPB Student ID Number

UAPB Email

Work Request Details

Building

Room Number

Location Of Problem (Examples: bedroom, suite area, sink, bathroom, etc.)

Description of problem

Has this problem been reported before? If so, to whom and when?

Contact Information