Housing Medical Exemption Request

Housing Exemption Information 

This Housing Exemption Application includes 3 sections: 

1. Student Information - This provides an opportunity for students to describe their disability and the accommodations they are requesting. Students should include experiences related to their disability, barriers faced, and/or previous accommodations received.
2. Medical Information - Supporting documentation should provide information on the impact of the student’s disability in order to identify appropriate accommodations.

• Common sources of documentation include Primary Health Care Professionals, Psychologists, Licensed Counselors, and Diagnosticians.
• Documentation should be typed on letterhead, dated, and signed by a qualified Licensed Health Care Professional.
• In all cases, the student requesting the Housing Exemption is responsible for providing the requested documentation necessary to be considered for a Housing Exemption.

Suggested Documentation Elements: 

• State the disability or disabilities
• Describe the impact or symptoms of the disability
• Current treatment plan in place directly related to a disability and exemption request
• If appropriate, discuss the severity and/or expected progression
• If relevant, list all medications and possible side effects
• Recommended accommodation(s)

3. Housing Exemption Application - To be completed by a Licensed Primary Health Care Professional or other Clinical Primary Health Care Provider. 

Completed Housing Exemption Applications includes:

1. Student Information – Completed by the Student
2. Medical Documentation – Completed by a Primary Health Care Professional
3. Housing Exemption Questionnaire: Completed by a Primary Health Care Professional
   • The Housing Exemption Questionnaire is important documentation as it contains vital information that is not often addressed in a typical doctor's note.

If you are requesting a Housing Exemption, carefully read the Housing Exemption Form regarding the: 

• Exemption Type
• Required Documentation to be submitted with the Application Form.

Note: It is important that you detail as much information as possible in your Personal Statement so the committee members can understand your situation and circumstance regarding your Medical Accommodation Exemption Request.

Note: Accommodation Requests may be ALTERED based on providing the student requested Housing Accommodation(s) in the Least Restrictive Environment.