The University recognizes that some students have circumstances that may require special attention when determining living and dining options. Please complete the information below and return to Tim Mansfield, Associate Director of Residential Life; Dr. Miller, Director of Health Services; Lynn Waldman, Director of Academic Support and Disability Services; or George Murray, Director of Food Services. This group will meet to review all applications and contact you with a decision thereafter.

Name: ______________________________________________   
Class Year: _________
ID#: _____________________  Phone: _______ Current Residence: ________________

Please describe in detail the accommodation (housing or dining) that you are requesting. How will this accommodation address your needs? Please attach any supporting documentation that verifies your need.