Students with disabilities or medical conditions that require accommodations must complete this form and submit it to the Disability Services office each academic year if they plan to live on campus. Students will be notified in advance if more current documentation is needed each subsequent year a housing accommodation is requested. In addition, the College, acting in good faith, reserves the right to request updated documentation at any time.
Services may include
Student's ID Number:
Student's Phone Number:
Student's Email Address:
Student's Campus Address:
Student's Permanent Address:
Student's Home Phone Number:
For which academic year are you applying?
I am requesting (check all that apply):
If "Other", please specify:
For first-time requests, or if your condition has changed, please provide reason(s) for your request, how the request relates to your condition, and attach documentation the clearly established need based on disability.
Air-conditioned rooms and single rooms are limited and are on a first come, first served basis.
Please submit all documentation necessary to process this request to firstname.lastname@example.org. If you have any questions, contact the Office of Disability Services.
Please use this opportunity to double check your entered information using the tabs on the left. Click the Submit button when you are finished.