Academic & Housing Accommodations Request Form
If you need assistance with this form, please call The Office of Disability Services at (508) 565-1208, or e-mail firstname.lastname@example.org.
A. General Information
High School Attended:
I am seeking:
Disclosure of Disability:
Traumatic Brain/Closed Head Injury
Mobility Impairment/Orthopedic Disability & Systemic Disorders
Date of Diagnosis:
Accommodation History/Request for Accommodations
Please select all that apply and provide further information if you answered yes to any of these questions below:
I received special education services in high school.
I have utilized academic support services in the past.
I have utilized assistive technology hardware/software in the past.
I have received housing accommodations at antoher school, camp, etc.
I utilize a service animal.
I utlize a personal care attendant.
I utilize specialixed equipment and/or medical equipment where I live/sleep.
I utilize a mobility device that requires storage space/access to a re-charge source.
Please provide any other accommodation history or disability information you feel is important for us to know:
Please list the academic and/or housing accommodations you are seeking to utlize at Stonehill College.
If you have any disablity related documentation that you would like to submit electronically, you may do so here.
If you are seeking a housing accommodation, you are required to write a personal statement to help us understand your request. Please upload your personal statement here.
C. Accommodations Process
Please submit documentation and this request form prior to scheduling an appointment with Elizabeth Orlando.
D. Housing Accommodations Process
Students must submit this request form and provide all documentation regarding their disability. This is a confidential form, that will be viewed by the Associate Director of Disability Services and Academic Achievement. New incoming students must submit their requests by July 1st. Returning students making requests for the next academic year must submit their information in accordance with the timeline established through the annual housing lottery process. Ordinarily this deadline is February 28th. Housing accommodation requests will be reviewed by the Housing Accommodations Committee. Students will receive written notifcation regarding the outcome of their requests. Students need to comply with all Residence Life Procedures.
I have read the College's Documentation Guidelines on the Office of Disability Services Web Page.
Should be Empty: