Housing Accommodation Request - Returning Students
Campbell University is a residential campus requiring all freshmen, sophomores and some juniors to live on campus during the academic year. This requirement is based on our belief that living in residence halls, where students learn to live in community and share space with others, is an integral part of the educational experience. Students with disabilities may need accommodations to fully participate in this experience. To request a housing accommodation, please complete the form below by March 26. Requests made after March 26 will be honored if possible, but cannot be guaranteed. You must have current medical documentation on file with Student Success to support this request. If not, please contact Student Success at firstname.lastname@example.org for more information.
Phone Number where you can be reached
Do you already receive disability accommodations (housing or academic) through Student Success?
No (if selecting this, please contact our office)
What is your current housing assignment? Include the residence hall name and room number, or type "off campus" if you do not live on campus now.
Describe any accommodation made with this housing assignment.
I am requesting accommodations for
Fall 2015 and Spring 2016
Fall 2015 only
Spring 2016 only
I will need on-campus housing during the summer of 2014.
Is this request related to a temporary injury or impairment? If so, please indicate the expected duration of the need for accommodations.
What is your documented disability?
Please explain, with examples, how your disabling condition impacts your daily life. Include a description of the environments, situations, conditions, etc. that exacerbate the symptoms you experience as a result of your disability. Please be thorough with your description.
A standard housing assignment is a two-person sleeping room where bathroom facilities are located on the same floor, and are shared by 4 or more students. All residential facilities are no more than four stories tall and some, but not all, have elevators. Most assignments, but not all, require the purchase of a meal plan. There are numerous locations on campus that provide quiet spaces for studying, including the Wiggins Library with its 24-hour quiet study areas and various academic buildings with lounges and other space available for study. Given the standard housing assignment and location options for quiet studying, describe how an alternative placement to the standard housing assignment is necessary to mediate the functional limitations of your underlying condition.
Roommates: Please list the names, student ID number and year of any preferred roommates (Gaylord Camel, 100000, Freshman). Consideration will be given, but placement with these roommates is not guaranteed.
Signature: By typing your name below, you are stating that the information contained in this request is true and that you release Student Success to discuss this request with Residence Life and the Dean of Students. Student Success will not release any medical documentation without further consent from you.
Do Not Fill This Out