Special Accommodations Request Form

Please complete the Special Accommodations Request Form in full and review the corresponding website for important information.

- indicates required field

(Disability or Chronic Medical Condition)

Please list the health care professional(s) you are authorizing to provide us with information about you. This will be used for consideration by the Special Accommodations Review Committee.

By my signature below, I give my consent for the Special Accommodations Review Committee to contact my treating professional for additional information as needed. Any such discussion will focus on the disability described on this form only.

Please make sure all required fields have been filled out correctly.
Your Special Accommodations Request Form has been submitted. Please allow 7-10 business day for the committee to review. You will be contacted via your UNA email with any additional requests or information. Please contact Housing & Residence Life  with any questions.