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Housing Accommodations Request

Students with disabilities or medical conditions that require accommodations must complete this form. This form must be completed and submitted to the Disability Support Services Office each academic year if you plan to live on-campus. You 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:

Ground floor room
Single room
Air conditioned room
Visual fire alarm
Visual door signaler

If you would rather print out a copy of the form and hand it in to the Office of Disability Support Services on the first floor of the Jenkins Education Complex, you may find a PDF copy here (PDF) .

Fields marked with an asterisk (*) are required.

Name*

Student ID

Phone Number*

Email Address*

Campus Address

Permanent Address

Home Phone Number

I am requesting (check all that apply):*Please select your requested accommodation(s).

Ground floor room
Air conditioned room (must have a doctor’s note)
Visual fire alarm
Visual door signaler
Single room
Other:

Please provide reason(s) for your request and how the request relates to your condition:*

Air-conditioned rooms and single rooms are limited and are on a first come, first served basis. An additional fee may be assessed for air-conditioned rooms and single rooms.

Leave this field blank.