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Verification Form for Housing Accommodations

In order to determine reasonable accommodations for housing, Angelo State University requires current and comprehensive documentation of the student’s condition from a licensed clinical professional or health care provider.

This form must be completed by a licensed clinical professional or health care provider familiar with the history and functional limitations of the student’s condition(s). The provider may also attach a report providing additional related information.

Common accommodations for health issues such as allergies, or diabetes will not require submission of this form. Please make sure to note requests for these types of diagnoses on your housing application.

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Please list all the relevant diagnoses.
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