Residence Departure Form - Housing and Residence Life Services

Carleton University Student Number*

Name*

First Last

Carleton Email Address (i.e. jamiesmith@cmail.carleton.ca)*

Enter Email Confirm Email

Room Number*

Residence Building*

Date of Departure*

Are you the last person to leave your room/suite?*

Yes
No

Have you locked your door?*

Yes
No

Do you reside in a building with metal keys? If yes, have you returned your keys to the Residence Reception Desk in Residence Commons?*

Yes
No

Metal Key Return

I agree that failure to return my metal keys will result in a lock change charged of $100 per lock, assessed to the Student Account.

Have you changed your address in Carleton Central?

Yes
No

Mail delivered to campus for residence students who have moved out is returned to sender. Please ensure that you update your mailing address with family, friends, and any online businesses you may order from. If you are expecting something that was sent prior to your move out date, please contact the Residence Reception Desk resdesk@carleton.ca for assistance.

Receipt of this check out form is confirmation that you have vacated your room/building. A room inspection will be completed and access will be removed. Please ensure you have not left any personal items in your room.

Room Inspections will be completed on bedrooms, suite areas, and bathrooms as follows:*

All drawers and cupboards empty and wiped clean.
All posters, tape, or markings have been removed from, windows, walls and ceilings.
Carpet has been vacuumed.
Bathroom floor, bathtub, shower, sink and toilet all clean.
All belongings and garbage has been removed.
Kitchen floor, cupboards, sink, fridge, counters, and appliances in Frontenac, Leeds, and Prescott Suites clean.
Double check all rooms, cupboards, drawers for any items you may have missed.
Door has been locked as you exited.

Upload pictures of your room and suite (if applicable) prior to leaving.*

Drop files here or

Please take pictures of your clean room/suite and upload them here as proof you have completed the above checklist.

I have completely moved out*

I acknowledge that I have completed the checkout process and am responsible for any damages, deficiencies, cleaning charges or other costs that are discovered during the inspection conducted by the Department of Housing and Residence Life Services staff after my departure. I can contact the Department of Housing and Residence Life Services to discuss any damages, missing items or issues prior to checking out.

Items left behind will be discarded*

I acknowledge that any items left behind will be disposed of and there may be a fee of a minimum of $100 for the removal of these items.

This collection notice may be appended to forms used by Academic and Administrative units to collect personal information from any individual who interacts with us. “Personal information collected through this form will be used and disclosed by Carleton University under the authority of the Carleton University Act, 1952, and in accordance with sections 39, 41 and 42 of Ontario’s Freedom of Information and Protection of Privacy Act. The purpose of this processing is to advise you have departed from residence. If you have any questions about the processing of personal information by Carleton University, please contact the Manager, Privacy & Access to Information, by phone at 613-520-2600 ext. 2047 or by e-mail via University_Privacy_Office@carleton.ca.” If the collection is occurring through a web form, you can create a PDF of the completed notice and create a hyperlink with the following statement. The hyperlink would be linked to the words “privacy notice”: “By clicking submit, you acknowledge that you have read the privacy notice and you consent to the uses and disclosures identified”.