Gitsegukla Housing Department

    Online Maintenance Request Form

    Paper form available from Reception

    Housing Manager: TBD - Job Posting
    Housing/IT Clerk: Erica Morgan ext 122

    Main Occupant Name*

    Address*

    Phone Number*


    Email:

    Do you have any outstanding debt with the Gitsegukla First Nations?*

    Soc. Dev. Client?*

    Elders in home?*

    Children under 19 at home?*

    Band-Owned?*

    Repair Category* (select at least one)

    Other Repair Details*

    When was the last time your unit was renovated? — Date & Year:

    Details of Request*

    Signature (type your full name to confirm)*

    (Optional) File Attachment 1:

    (Optional) File Attachment 2:

    ** By pressing "Send" you agree to have the details entered into this form, submitted to the Housing department for review. By sending, you also assure that the details in this form are accurate to the best of your knowledge, and agree that you will not submit information on behalf of another party.

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