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For first-year and transfer students.
Associate and bachelor's degree programs for men and women 4 full years out of high school.
Elementary and secondary certification for men and women with a bachelor's degree.
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Please note that the information on this form and any applicable documentation may be shared with the Academic Support Center Director and/or Assistant Director, as well as the Director of Counseling and/or College Nurse, as is appropriate. If you have questions about accommodations, please contact the Academic Support Center at 717-264-4141 ext. 3349 or via email at firstname.lastname@example.org.
ANY INFORMATION PROVIDED ON THIS FORM IS STRICTLY CONFIDENTIAL
All accommodation requests must be supported by a detailed letter from your health care provider stating why a special housing accommodation is needed. Specifically, documentation MUST contain the following:
*Specific diagnosis and current treatment plan, if the latter is applicable.
*Description of necessary housing arrangements and possible alternatives if recommended accommodations are not available.
*Statement relating how the proposed housing arrangement will benefit the student and impact the diagnosed condition.
This letter must come from a specialist qualified to make this diagnosis; it may not come from a relative of the student; and it must be typed on letterhead and signed (no prescription pad notes will be accepted).