Housing & Dining Accommodation Request Form

To request Housing & Dining accommodations:

Complete the Housing Application to initiate the housing assignment process.
Complete this Housing Accommodation Request Form to establish contact with the SDC and initiate the accommodation request process. SDC staff may reach out to you to clarify information provided in this application before arranging logistics with Housing & Dining.
Once you have confirmed enrollment at CSU, meet with the SDC staff via phone appointments to submit documentation and arrange further logistics before arrival. If you are already living on campus, you will meet with SDC staff to arrange logistics for receiving accommodations while already on campus.
Once housing has been assigned, accommodations have been provided, and you have moved into your residence hall or apartment, you will receive a visit from your Residence Director or Apartment Manager to check on your accommodations.
Notify SDC staff and Residence Hall staff immediately if you have any questions or concerns about accommodations. You may contact the SDC at 970-491-6385 or sdc@colostate.edu.

Name*

First Last

CSU ID*

Email*

Phone*

Pronouns

Other (please write in)

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

Which semester will you be attending CSU and living on campus?*

I currently attend CSU and living on campus
Summer
Fall
Spring

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.

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

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.

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