Services received in high school via IEP or 504 may be significantly different at the university level. In the case of specific housing accommodations, we will need the above-mentioned documentations, with specific documentation for the need of provide accommodations.

ALL documents must be completed, signed, and submitted via email no exceptions. It is the student's obligation to complete and submit all needed documents each school year.

This questionnaire is intended to help the diagnosing professional provide acceptable disability documentation and can be provided in place of a typed report. Written or printed document must be on official letterhead which includes the address, telephone number, name, title, and professional credentials of the evaluator. All typed documents must be accompanied with an official letterhead.

Student Information

Full Name:

CWID:

Date:

Major:

Present Academic Status: (Circle One)

First Year Second Year Third Year

Other

Requested Accommodation (circle one): SINGLE ROOM FIRST FLOOR OTHER If selected “OTHER,” please specify below: