ASSIGNMENTS QUESTIONNAIRE
For New Residents with Physical Disabilities

• Please provide a brief description of your physical disability.

• Do you use a wheelchair or scooter daily?

Yes No

• Width of wheelchair or scooter in inches

• How many wheelchairs or scooters will you bring?

• Please list quantity and type you will bring
  

• Can you lock/unlock a standard deadbolt using a key?

Yes No

• What special large equipment will you bring (hospital bed, lift, etc.)

• Will you or your equipment require more space than what is commonly allotted in
  a residence hall space?

Yes No
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