Earlham College Academic Enrichment Center
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Special Housing Assignment Requested
as a Disability Accommodation

The primary functions of a residence hall is to provide students with personal living space and a place to develop community. We aspire to assign all students to the most appropriate living space possible. Please assist us in our endeavor by submitting a completed form before May 25.
Name and e-mail fields are required.

Personal Section
Full Name:
Date of Birth: / /
Phone:
E-mail:
Street Address:
City: State: Zip:
Country: (if outside USA)
Requirements - Section A
Marking a box indicates the statement is true.
My Housing Questionnaire has been submitted to Residence Life.
I require:
a single room a quiet residence hall
an air conditioned residence hall a semi-private bathroom
a first floor room room space for a service animal
a residence hall with a elevator access the assistance of a
personal attendant (Earlham does not provide personal attendants)
a room with accessible features (complete sections B - E)
Other:


Please list the major life activity(ies) accommodated through this requirement.
 

Section B

Bathroom in Residence Hall

Minimum height of sink:
Maximum height of sink:
Desired height of toilet paper holder:
Require a roll-in shower Require a shower seat
Require grab bars in the toilet stall Require assistance from attendant in the toilet stall

Section C

Common Areas in Residence Hall

I plan to do some cooking. I plan to use the washer and dryer.


Section D

Residence Hall Room Furniture and Accessories

Standard furniture and accessories will be provided unless special instructions are noted below. Please be aware that it may take six weeks for the arrival of new furniture and equipment.
Minimum height of bed mattress:           
Maximum height of bed mattress: 
Minimum height of chest of drawers:
Maximum height of chest of drawers:
Minimum height of closet rod and shelves:
Maximum height of closet rod and shelves: 
I do not require a desk chair.
I require a window lock installed at the lowest reasonable height.
I require Venetian blinds.
All control knobs/switches must meet the ADA guidelines.
I prefer a:
rockable-sled deck chair four-legged desk chair.


Section E

Additional Accessories for the Residence Hall Room

Please be aware that it may take six weeks for the arrival of new equipment.

Visual door knocker Strobe fire alarm
Automatic door opener Braille signage
Extra space for disability related equipment Extra power/outlets for disability related equipment

An accessible phone with:
an Amplified handset TTY Voice Carry Over/ TTY.

Please list the equipment you will bring with you and their dimensions.
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Earlham College · 801 National Road West · Richmond, Indiana 47374-4095
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This page last updated:March 23, 2005