Housing Accommodation Request

Please Note:

By completing this form, you authorize the Housing Accommodations Selection Committee to receive and share information from your medical provider. Documentation will be kept in a confidential file available only to members of the Housing Accommodations Selection Committee. The committee’s decisions will be announced shortly after the deadline for each semester and students will be notified in writing.


Personal Information


Male Female Transgender

Current Wentworth Address

Home Address


Please describe the housing accommodations that you are requesting:






Please note that all requests must be accompanied by documentation from your medical care provider. You can mail this information to: The Center for Wellness and Disability Services, Wentworth Institute of Technology, 550 Huntington Avenue, Boston, MA 02115

Doctor/Medical Care Provider’s Information

Doctor/Medical Care Provider’s Address:





Please contact The Office of Housing and Residential Life at 617-989-4160 with any questions.

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