Only Housing Accommodations Application

This form is for students who have a disability, defined as "a physical or mental impairment that substantially limits one or more major life activities". You must provide documentation of necessity from a medical or mental health provider licensed and in good standing in the state of Texas. Please allow 2-3 weeks for review and processing. If you are requesting an ESA (Emotional Support Animal), do not bring your animal onto campus until final approval is received by Islander Housing.

You must already have completed an Islander Housing Application before submitting a housing accommodation request. Please use this form to submit your disability housing accommodation request.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID - (Your "A" Number):
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Islander Email Address *:

Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Additional Note:

Home
- Online Services Home

Page Tabs

Only Housing Accommodations Application

Page Options

Questions

Navigation

Home