Short-term Disability Needs
In the event of injury resulting in temporary accommodation needs, Occidental College will make every effort to provide accommodations, whenever possible. Please complete this form and a staff member will reach out to begin coordination.
Student Name: *
Your answer
Student ID #
Your answer
Relationship to Student: *
Please briefly describe the injury/illness that requires temporary accommodation:
Your answer
Does the student require a temporary housing accommodation? If so, please describe (i.e., lower campus, first floor/no stairs, etc.):
Your answer
Does the student require special equipment? (i.e., crutches, scooter, wheelchair, etc.) If so, please describe:
Your answer
Is transportation (with or without medical equipment) necessary? If so, please describe:
Your answer
Are temporary academic accommodations and/or communications with faculty required? If so, please describe:
Your answer
Expected recovery date:
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