Oklahoma State University Housing Application for Students Requesting Accommodations
Name:______________________________
Student ID#_____________ Semester/Yr._______
*The information requested is to document a disability, determine the
severity, and will be used to help determine reasonable accommodations
for living on-campus. All disability-related requests require appropriate
and complete documentation. Please complete this form and/or attach a
doctor's statement/report (a doctor's statement/ report will be necessary
for special classroom accommodations also). The information will be protected
as a confidential file in the Student Disability Services office. Thank
you.
Disability diagnosis: Tests/Evaluations used. Dates & results of tests/evaluations: Brief history of functional issues: Present functional issues: Current prescriptions and/or treatment: Recommendations regarding accommodation needs (please provide a continuum
of possibilities, if they exist):
Return to: Student Disability Services, 326 Student Union, OSU,
Stillwater, OK 74078
|
