Medical Accommodation Request Form 2013-2014
Dominican ID Number
Dominican Email Address
Check all that apply (in the case of a transfer student)
Please explain your medical accommodation request(s). In addition, a doctor's note, using the form listed on the Residence Life website, must be turned in to the Dean of Students Office by 4/1/13 for approval.
Thank you for your submission.
If you have questions, please contact the Office of Residence Life at firstname.lastname@example.org or x. 6217.
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