Residential Accommodation Documentation Form

The Office of Student Accessibility (OSA) at Lewis & Clark College provides reasonable accommodations for students with disabilities that enable them to access, use, and enjoy the College's residential facilities in a manner commensurate with their peers.

Your patient/client is requesting disability-related residential accommodations at Lewis & Clark College. OSA is engaging in an interactive process with your patient/client to determine whether their disability-related request for a residential accommodation(s) is reasonable and necessary in order to ensure equal access to their residential environment. Your detailed responses to the questions below will assist OSA in this process. This form should be filled out by the licensed provider who is treating the condition that requires a residential accommodation(s).

Federal laws define a person with a disability as “any person who has a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment.” Major life activities include, but are not limited to: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, and communicating.

Before completing this form, please refer to OSA's webpage on residential accommodation information and guidelines.

The information provided on this form is considered confidential, and is viewable by OSA professional staff only.