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Housing Accommodation Request Form

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Your Information

If you do not know your ID#, please enter 0000000 (7 zeros)

Housing Options

Please enter the semester and/or academic year, for example: Spring 2021 or Fall 2021/Spring 2022.

Disability and Accommodations

Please describe your disability and how it affects your needs in your living environment (in your own words). Please note that you will also be required to provide documentation of your disability signed by a licensed clinician, learning specialist or other qualified diagnostic professional that details your needs specific to your living environment.

Please list the type of accommodations you are requesting i.e. single room, fewer roommates, lower floor, ADA accessible, Personal Care Attendant, etc.
Upload Documentation
Please attach your documentation of your disability here (please note your documentation should meet CCA's documentation guidelines, found on on Access/Disability Services on  

You can upload up to three files - to upload more than three files, please add them to a single zip file before uploading.

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