NDSU Disability Services
Fostering equal access, self-advocacy and inclusion

Residence Life Accommodations on the Basis of Disability or Medical Need

STUDENT REQUEST FORM

Student Name: / Today’s Date:
Student ID #:
Year in College: / Incoming Student / Current Student
On Campus Address:
Email: / Telephone #:

Please indicate the housing accommodation(s) you are requesting:

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 Air conditioning

 Single Room

 Emotional Support Animal *

 Wheelchair Accessible

 Strobe Light Emergency Alerts

 Close to a Bathroom

 Other: ______

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Write a paragraph identifying your rationale for the requested accommodation(s). Be specific regarding all circumstances relevant to your request. (You may attach a typed statement, if you prefer)

Before turning in the request for residence life accommodation, on the basis of disability or medical need, please initial each statement and sign at the bottom:

_____ I understand that by turning in this request for accommodations, I am claiming to have a
disability as defined by the American with Disabilities Act (ADA).

  • A disability is a physical or mental impairment that substantially limits a major life activity in comparison to non-disabled person.

_____ I understand I will need to provide documentation from a qualified providing health
professional before my request is considered.

_____ I understand the role of Disability Services is to determine if my documentation confirms
the presence ofa disability and that the condition requires a reasonable accommodation.

  • If my documentation does not confirm the presence of a disability or my requested accommodation is not considered reasonable based on the individual need, my residence life request will be denied.

_____ I understand I may be required to disclose that I have a disability.(for example, a student
with an emotional support animal may need to notify roommates, suites mates and
others that he/she has a disability).

_____ I understand that this process may take up to 60 days after the receipt of the completed
requestform and documentation.

  • The only exception is in the case of an emergency or medical change. In this instance, information from a doctor documenting the urgency of the matter will be required.

_____ I understand that I will be notified by the Disability Services Department, via my NDSU
email account,regarding the status of my request.

_____ I understand that if my request is not complete, it will be denied.

_____ Student Signature: ______Date: ______

Provider Documentation Form – For general Residence Life Requests please have your health care provider complete thisform.

Provider Documentation Form* – For Residence Life Request – Emotional Support Animal – please have your health care provider complete thisform.

*Emotional Support Animal – Documentation Advisory

  • Specific documentation is required when requesting an ESA and must be delivered directly from the student’s health care provider to Disability Services at least 60 days before a student’s move in date.
  • Please be aware that documentation provided by online verification services and other providers with whom you do not have an ongoing therapeutic relationship, will likely not be accepted.
  • Also of note: there is NO state or federal entity that requires an emotional support animal to be registered. Registering an animal with any entity is not proof of your animal’s eligibility nor helpful in getting a request for an emotional support animal approved.

Acceptable documentation guidelines for Emotional Support Animal Residence Life Requests:

-The NDSU ESA Documentation Form must be completed, in full, bythe student’s a qualified providing health professional who is directly responsible for the ongoingtreatment of the student’s disability.

-Documentation must include information about how the animal alleviates one or more of the identified substantially-limiting major life activities.

-The provider completing the form may not be a relative of the student or the student.

-Please note: A student is not permitted to bring an emotional support animal to campus prior to receiving written approval from Disability Services and meeting with Residence Life staff.

Link to NDSU Animals on Campus policy:

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