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REQUEST FORM - MEDICAL BUYOUT

General Information
LAST NAME
FIRST NAME
PHONE NUMBER ( )    -

This form is for residents with physical disabilities to use if they are requesting a double room as a single -"buyout". Residents requesting a double room as a single could be considered for an accessible single room instead of a under assigned double room. The Office of Residence Services will only approve "buyouts" if the student has extremely large equipment or 24 hour nursing care.

 

Please explain in detail why you would like to have a double occupancy room as a single occupancy room. Please provide any pictures or information about the large equipment to be used in the room.

 

Please forward this form and questions about buyouts to Wray VanVoorhis, Residence Services 3640 Col Glenn Hwy, Dayton, OH 45435 937-775-4172. Upon received the request will be considered and answered by mail.  


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3640 Colonel Glenn Highway - Dayton, Ohio - 45435
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Last updated: Thu. Jun-06-13, 13:41
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