Online Housing Application

NOTE: Current and/or returning students applying for disability accommodations in housing must first complete an application with the Office of Residential Life and Housing Service and participate in the housing lottery at their assigned date/time to select a room that best meets their needs.

If after the lottery you still require a housing accommodation, then please complete this form.

Be advised that requests for housing accommodations for Fall 2023 will start being reviewed in May 2023.

Students making requests based on special dietary needs or food allergies must first consult with the Campus Health and Wellness Coordinator; email: rcnutrition@services.rochester.edu or phone 585-273-4805.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Primary Campus *:
Note: Please select campus location where you will be enrolled.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 8 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:
Pronouns:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
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

Campus Location(s)

Arts, Science & Engineering

Eastman Institute for Oral Health

Eastman School of Music

School of Nursing

Simon School of Business

URMC Graduate School

URMC Medical School

Warner School of Education
Additional Note:

Questions

Please indicate your primary disability diagnosis: * (Required)
Please list any secondary disability diagnoses (if applicable): * (Required)
What accommodation(s) are you requesting?

Single room

Exempt from housing contract

Emotional support animal

Strobe fire alarm/doorbell

Other (Specify Below)

Additional Note or Comment
Please explain why you are requesting the accommodation(s). Your answer should describe your disability, its impact, and the specific housing accommodation you are requesting. * (Required)
Would your disability hinder your ability to evacuate a building in the event of an emergency? * (Selection is Required)

Yes (Specify Below)

No

Additional Note or Comment
Please review our documentation guidelines at http://www.rochester.edu/disability/documenting.html and submit appropriate documentation for your disability. * (Selection is Required)

I am uploading my disability documentation at this time. (You will be prompted to do so after you submit this form.)

I will fax, mail, or hand deliver my disability documentation to Disability Resources. (See confirmation email message for fax number and mailing address.)

Additional Note or Comment

Page Tabs

Online Housing Application

Page Options

Campus Location(s)

Navigation

Home

Need Help?

Office of Disability Resources