Special Housing Accommodation Request Form

To request or receive special room accommodations for a medical condition or documented disability at Regis University, you must submit information regarding your request and the condition for which you are being treated. Students must complete page one and a qualified, impartial medical provider must supply the University with the information outlined on page two. Your medical provider cannot be a family member and must be the specialist with whom you are working in regards to your specific request. All documentation must be provided to Student Disability Services & University Testing before your request will be reviewed.

By submitting this paperwork, you authorize Regis University Medical Staff to cross-reference this information with your medical provider, if necessary. If not attached to this form, medical providers must mail or fax documentation letter including all necessary information and any supplemental materials:

Student Disability Services & University Testing
Regis University
3333 Regis Blvd. G-18
Denver, CO 80221
fax: (303) 964-6595

Student completes this form:
Gender: *
0/1000 words