Disability Verification for Housing

If you need special accommodations for housing, please complete this form.

Housing Accommodations Guidelines

The Office of Residential Life and Learning and Disability Support Services (DSS) work together to accommodate students with disabilities in residence halls. Students may request accommodations in their residence hall by completing a Housing Accommodation Request form, which includes documentation from their physician or other appropriate professional that verifies the student has a substantially limiting condition.

Please complete the following forms and submit documentation to LCCC Disability Support Services:

Student-completed form: "Housing Accommodations Request Form"
Student-completed form: "Release of Information" OR
Documentation that verifies disability

LCCC has established Documentation Guidelines that set standards for appropriate and acceptable documentation of a disability. Documentation must be provided by an appropriate professional and requires the following:

• Diagnosis of the student's current disability
• Date of the diagnosis
• How the diagnosis was reached
• Credentials of the professional
• How the disability affects a major life activity
• Signature of person making diagnosis

The documentation must provide enough information so that the student and the DSS staff can determine appropriate housing accommodations. Copies of the Documentation Guidelines are available in the DSS office. If a student does not have documentation of his or her disability or the documentation provided does not meet the Documentation Guidelines set by LCCC, it is the studen's responsibility to pay for or find funding to pay for an appropriate professional to document the disability and the need for accommodations. The DSS does not provide diagnostic testing.

The requests for housing accommodations must be submitted to the Disability Support Services office prior to June 15 each year. Housing requests turned in prior to June 15, will be accommodated based on date of submission and space availability. Requests turned in after June 15 will be subject to space availability.

Submit forms and required documentation to:

Laramie County Community College
Coordinator, Disability Support Services
1400 E. College Drive
Cheyenne, WY 82007

307.778.1359 Fax: 307.778.1262

Only fill out this form if you have a disability and need housing accommodations.

Student Information (no nicknames please):

Last Name
First
Middle
ID Number
Date of Birth (mm/dd/yyyy)
Home Phone
Home E-mail

Semester and/or year to which this request applies:

Home Address:

Street

City
State
Zip

Are you a:

	New Student
	Returning Student

Please list specific housing accommodation(s) requested and explain need based on a documented disability.

Justification*

Have you sent in documentation to verify your disability?

	Yes
	No

Signature

	By checking this box, I certify under penalty of perjury that the information presented is correct and accurate to the best of my knowledge.
	Date: Date:

*Note: The Disability Support Services Coordinator reviews requests to ensure the disability is a “substantially limiting condition” as defined by the Americans with Disabilities Act.