Get Housing Accommodations Request Form (pdf) - Housing, Food ... - Hfs Psu

Filling out the Housing Accommodations Request Form is an important step for students seeking reasonable accommodations in University Housing. This guide will provide you with clear, step-by-step instructions to ensure that the form is completed accurately and submitted on time.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing Section A: Student Information. Provide your full name, PSU ID, date of birth, email address, and home and local addresses. Fill in your phone numbers under both categories as well.
3. Indicate your gender by selecting the appropriate option. You are required to authorize Penn State to receive information from your healthcare provider by checking the box and signing your name.
4. In Section A, ensure to check the box indicating you have read the instruction page regarding submission deadlines. Sign and date this section.
5. Optionally, provide the names and contact information for any individuals authorized to discuss your request on your behalf. Complete their relationship to you and sign again if applicable.
6. Next, move to Section B: Healthcare Provider Section. This section will be filled out by your licensed clinical professional. They need to provide detailed documentation about your condition and the recommended accommodations.
7. In Section B, your provider should describe in detail how your medical condition necessitates housing accommodations. They will also indicate the specific recommendations and rationale related to your health.
8. Your healthcare provider will also need to complete the verification section at the end of Section B, including their signature, date, and license number.
9. Review all completed information for accuracy. Ensure that both sections are properly filled out and signed, then follow the instructions for submission.
10. Once finalized, save the changes, and either download, print, or share the form as needed. Submit the completed form via fax, email, or mail as provided in the instructions.

Complete your Housing Accommodations Request Form online today to ensure your needs are met.