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2019 MAQ Emergency Contact, Special Needs and Roommate Request
This form should be filled out AFTER registering and paying for classes and housing.
Your email address
Emergency Contact Name (while at MAQ)
Emergency Contact Phone Number (while at MAQ)
Roommate requested (if in double)
I have a disability and hangtag for parking issued to me by my state.
I will be staying on campus and need a handicapped accessible (ADA) room.
I will be using a wheelchair on campus.
There are no elevators in the dorms. Do you require a room on the first floor? We will try to accommodate this, but it is not guaranteed.
Please describe any special needs you have, including any accommodations you need.
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