Online Housing Application

Welcome to the Accessible Education Center!

Please complete the questions below. This information is required to assist in determining eligibility for services.
Students seeking accommodations are also required to provide formal documentation to the office from the appropriate evaluator. Documentation Guidelines are available on the Accessible Education Center website or by emailing disability@tntech.edu.
The Accessible Education Center may require further documentation to substantiate the request for accommodations.
All information submitted to AEC will be maintained and used in accordance with applicable confidentiality requirements.
Communication from AEC will be prompt, using the student's official TTU email address as the primary mode.
Both this form and supporting documentation must be received before a review will proceed.
If you have questions or would like to meet with AEC staff prior to submitting a request, please email disability@tntech.edu.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:

Contact Information

Local Address

Permanent Address Same as Local Address

Additional Information

What semester are you applying for?
What is your disability/diagnosis?*
When were you last evaluated or given diagnosis of your condition by a provider?
Are you currently receiving treatment? * (Selection is Required)

Yes (Specify Below)

No

Additional Note or Comment
Are you taking any medications? Describe why medication is prescribed and whether it is effective or ineffective.* * (Selection is Required)

Yes (Specify Below)

No

Additional Note or Comment
How does your disability currently impact campus housing and/or other areas of campus life?*
What accommodations are you requesting? (Please be as specific as possible)
Have you received accommodative support for your disability in the past (i.e. IEP, 504 Plan, accommodations at college/university)? If yes, please describe and submit a copy of past accommodations to supplement documentation. *Please note: past accommodations do not guarantee future accommodations * (Selection is Required)

Yes (Specify Below)

No

Additional Note or Comment
Have you used any support services to assist in managing the impacts of your disability? (i.e. counseling, coaching, social support services)?* * (Selection is Required)

Yes (Specify Below)

No

Additional Note or Comment

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