Special Housing Accommodation Request Form

Special Housing Accommodation Request Form

The Residence Life Office is committed to providing students with disabilities an equal opportunity to access its residential community. We partner with Anderson’s Center for Student Success to provide reasonable accommodations for students with medical, physical or psychological conditions. Qualification for accommodations is determined by the Center for Student Success.
Full Name*

First NameMiddle NameLast Name
Student ID Number*
AU Email Address*
Phone Number*

Area CodePhone Number
Type of Disability*
In this space, please detail your request and include the type of housing requested (if applicable), and the reason(s) for your request*
If medical documentation for this specific request is already on file with Anderson University, please indicate the department that holds that documentation
Please attach appropriate documentation from a medical professional regarding your disability.
For current students only: Please list your top 3 room choices. All choices are subject to availability.
Request Deadlines:

Students must submit the appropriate documentation prior to the deadlines listed below. New or urgent conditions will be considered upon receipt. Please note that if a student with an approved need turns down the opportunity to live in a space that accommodates their need, the approval may be cancelled by Residence Life.

New Students:

Requests submitted after the May 1st Priority Housing deadline will be considered late and may result in a processing delay or lack of availability of the requested housing accommodations.

Returning Students:

Requests submitted after the housing application deadline will be considered late and may result in a processing delay or lack of availability of the requested housing accommodations.
Any Questions?
The submission of the Special Housing Accommodation Request Form does not guarantee Residence Life will be able to accommodate your requests. Furthermore, the Center for Student Success may require you to provide additional information in order to consider your request.*

I understand the above statement.
Student Signature
Should be Empty: