SEATTLE UNIVERSITY

REQUEST FOR DISABILITY-BASED ACCOMMODATIONS IN HOUSING

After completing the online applicationformatMyHousingPortal, please provide the information requested on this form and attach documentation of your disability-based needs. Please set up an appointment with a Disabilities Services staff person. Return the form and accompanying documentation toDisabilities Services in Loyola 100 on or before your meeting. Disabilities Services staff will consider each accommodation request on a case-by-case basis. They will inform you of their decision and forward their recommendation to the Housing and Residence Life department.

Please Note:

  • Documentation must be from a qualified, professional service provider and otherwise fulfill the Seattle University Requirements for Disability Documentation that can be found at:Documentation Policy. You may use the Documentation Verification Formfrom that same location, if you prefer. The documentation should address how the specific request (single, kitchen, etc.) will help to address access issues due to the disability.
  • Requests for specific rooms or roommates are typically preferences that should be requested through the online HRL process, not by using this form. They will be addressed through the regular housing process.
  • The deadline for requests that are part of the room selection process is April 14th. Requests submitted after April 14, 2017 will be subject to availability and/or may delay the implementation of housing accommodation.
  • Students who are new to Seattle University or current students applying for housing should note their intention to request accommodations on their housing application form. In order to be considered for accommodations please submit this form along with all accompanying documentation.

Disabilities Services 206-296-5740

901 12th Avenue FAX 206-296-5747

Seattle, WA 98122

Name ______Date Submitted ______

Student ID ______Phone Number ( ) ______

Class Level (Circle all that apply)FRSOJRSRTransferOther

1.)What housing modification are you requesting? ______

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2.)What disability-based needs will this address, and how will modification address the needs?

(If you want to provide additional information, please attach a letter.)

______

______

______

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3.)If fulfilling the request is not possible, what alternative(s) might be helpful?

______

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Please sign to indicate your permission for Disabilities Services staff to share their recommendation with the Housing and Residence Life Staff:

Signature ______Date ______

For DS office use only:

DS Staff Member ______Date ______

Recommend the following accommodations ______

______

______

______

Comments regarding student preferences ______

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