Housing & Dining Accommodation Request Form

Are you requesting accommodations related to housing or dining? Please fill out this request form so we can collect some preliminary information to assist us in reviewing your requests, and if approved, communicating with Housing & Dining Services in a timely manner. Please note, the request for housing and dining accommodations is a process and must be approved by the Student Disability Center before taking effect. We highly encourage students complete this form and/or contact the SDC in advance of moving into CSU to ensure their access needs are met.

To request Housing & Dining accommodations:
Name*
First Last
CSU ID*
Email*
Phone*
Pronouns
Other (please write in)
What semester are you submitting this request regarding (e.g. Fall 2022)*
Have you submitted a Housing Application?*
- Yes, I have submitted by application.
- I am currently in the process of submitting my application.
- I have not submitted my housing application
I would like to request accommodations related to the following impairment(s)/disabilitie(s).*
Select all that apply.
- Autism Spectrum
- Emotional/ Mental Health
- Environmental Condition
- Hearing or Vision
- Learning Disability/ ADHD
- Physical or Mobility
- Food allergy or sensitivity
- Other (please explain)
I would like to request the following accommodations related to an environmental disability
Select all that apply.
- Environmental/temperature controls
- Air filtration system
- Other (please explain)
I would like to request the following accommodations related to a hearing/vision disability.
Select all that apply.
- Strobe fire alarm
- Braille keycard
- Other (please explain)
I would like to request the following accommodations related to an emotional/mental health disability
Select all that apply.
- Single occupancy room (in a suite)
- Single occupancy room with single bathroom
- Emotional Support Animal (ESA)
- Other (please explain)
I would like to request the following accommodations related to a physical/ mobility disability.
Select all that apply.
- Ramp to the entrance of my dining and residence hall
- Manual wheelchair user
- Power wheelchair user
- Fatigue related to traveling long distances
- Roll-in shower (36" x 60")
- Transfer shower (36" x 36")
- Single occupancy within a suite
- Single occupancy no suite
- Grab bars
- Bidet, shower chair, or commode
- Automatic door openers
- Leaver handles for doors and drawers
- Accessible parking space for residence
- Caregiver accessible parking space
- Adjustable bed and/or desk
- Elevator access to my dining and residence hall
- Accessible mailbox
- Specified height for counters, outlets, etc. (More information will be requested)
- Other (please explain)
I would like to request the following accommodations related to a food allergy or sensitivity.
Select all that apply.
- Modified dining plan
- Clearly labeled and separated food space
- Exemption from dining plan
- Other (please explain)
I would like to request the following accommodations related to Autism Spectrum.
Select all that apply.
- Single occupancy room (in a suite)
- Single occupancy room with private bathroom
- Other (please explain)
I would like to request the following accommodations related to a Learning Disability and/or ADHD.
Select all that apply.
- Other (please explain )
Other (please write in)*
Please help us understand how the accommodations you've indicated above are necessary in providing you access related to your disability?*
Be sure to address all accommodations requested and specify measurements, heights, path of travel, and details required for your effective and equal access.
Documentation
If you have documentation of your disability readily available, you may upload it to this form to provide to the Student Disability Center as part of the accommodation request process. If you do not currently have documentation at the time of the application, you may submit the application and provide the documentation later, if necessary. Documentation must include specific details about the housing and/or dining needs related to the diagnosed disability.
Drop files here or

Accepted file types: doc, pdf, docx, Max. file size: 31 MB.
I understand
- I must meet with the SDC staff after submitting my Housing Accommodation Request Form to complete the accommodation process and arrange the logistics of my housing & dining accommodations .
- Appropriate documentation is required in order to receive accommodations.
- It may be necessary for SDC to discuss my needs for accommodations with other entities on campus as appropriate to my situation. Specific disability information will only be shared with appropriate university personnel on a need-to-know basis. All efforts will be taken by SDC staff to ensure any information is used in a non-discriminatory manner.