Residence Check Request Form

Housing residents on campus that do not live in a residence hall may request a patrol check of their residence while they are on vacation or away from home for an extended period of time. The request may be submitted by calling Dispatch at (949) 824-5223 or by completing a "Residence Vacation Check" form in person at the Administration's front counter or via the online form below.

Resident Information
Leaving Date & Time:
Returning Date & Time:
Resident's Name:
Street Address:
E-mail Address:
Emergency Contact (telephone numbers and dates):
Responsible Person Information
Day telephone:
Night telephone:
Vehicle Description:
Keys to house:
Residence Information
Pool in yard:
Pets in yard:
Pets Type:
Newspaper stopped:
Mail stopped:
Rear yard locked:
Broken windows/screens:
Broken windows/screens location:
Is anyone authorized to be in your residence while you were away? (Family member, Gardener, Housekeeper, Pet Sitter, etc.)
Please list who, when, relationship, purpose, and description of their vehicle:
Do you authorize UCIPD to enter your backyard to conduct a security check?
Lights on inside:
Cars in driveway:
Cars Make, Color, and License:
Alarm Company Name:
Alarm Company Phone: