Housing - FIXIT Request
Name
*
Date of request
*
/
MM
/
DD
YYYY
IU South Bend ID Number
*
IU South Bend Email
*
Phone
*
-
Area Code
-
Prefix
Line Number
Work Request Details
Building
*
Whitewater
Oxbow
Riverview
Crew
Bridge
Watershed
Creek
Portage
Community Building
Room number
*
100
101
102
103
104
105
106
107
200
201
202
203
204
205
206
207
Community Building
Location
*
Bedroom A
Bedroom B
Bedroom C
Bedroom D
Living Room
Bathroom
Kitchen
Porch
Community Building
Description of problem:
*
Is this the first or second request for this problem
*
First
Second