University of North Carolina Wilmington
DISABILITY ACCOMMODATION REQUEST
FOR UNIVERSITY HOUSING
Applicant Information
Name (Last, First, MI)_______________________________________________________ UNCW ID: 850________________________
EMAIL ADDRESS:
______________________@uncw.edu
[Alternate Email ________________________________]
PREFERRED PHONE: (_____)_____________________________________________
Permanent
________________________________________________________________________________________
Address
________________________________________________________________________________________
ANTICIPATED MOVE- IN DATE_____________________________________________________________________
OR
CURRENT UNCW HOUSING (SPECIFY LOCATION) _______________________________________________
Current Academic Status:
Freshman
Sophomore
Junior
Senior
Specific Nature of Disability Accommodations Being Requested:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
In most instances, housing adjustments due to ADHD and Learning Disabilities are not appropriate.
Housing accommodations for students with documented disabilities are determined based on the need for
equal opportunity; this determination is not made based upon a perceived benefit to the student.
Appropriate Disability Documentation must be submitted with Disability Accommodation Request.
Medical and psychological documentation will be confidentially maintained by Disability Resource Center as per its
policies, and will not be shared with The Office of Housing and Residence Life.
Students with Service or Assistance Animals planning to live in campus housing should also submit FORM
1.A with their Disability Accommodation Request for University Housing
[DO NOT WRITE BELOW LINE—FOR DRC OFFICE PURPOSES ONLY]
The requested accommodation is supported by documentation provided to DRC:
Referred to Student Health for Medical/
Request is Supported by DRC
Health consideration
Not Supported/No Documentation provided
NOTES/COMMENTS:___________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________
Signature & Date
___________________________________________________
Forwarded to:
___________________________________________________
DRC Authorizing Official& Title
___________________________________________________
Date
10/2015
V 1.0
Process for Requesting Housing Accommodations
1. Submit DISABILITY ACCOMMODATION REQUEST FOR UNIVERSITY HOUSING form and supporting
documentation to:
UNCW Disability Resource Center
601 S College Road
Wilmington, NC 28403-5942
DisabilityAdmin@uncw.edu
Fax: 910-962-7556
2. Following review by DRC, DISABILITY ACCOMMODATION REQUEST FOR UNIVERSITY HOUSING
form will be forwarded to UNCW Office of Housing and Residence Life (HRL). Documentation will
be confidentially maintained by Disability Resource Center as per its policies, and will not be
shared with The Office of Housing and Residence Life.
3. HRL will communicate with the student to determine appropriate housing arrangements.
For questions or additional housing information, contact:
Office of Housing and Residence Life
University of North Carolina Wilmington
601 South College Road
Wilmington, NC 28403-5959
http://www.uncw.edu/Stuaff/housing/contact.html
Phone: 910-962-3241
Fax: 910-962-7032