Online Housing Application

This form is used by students with a disability that impacts their ability to fully participate in housing or dining at New England College. The form will need to be completed by the student and will only be considered complete when documentation from an objective health care provider is uploaded. Students are also encouraged to complete the ODS Student Self-Assessment form prior to meeting with ODS so that we can get a better understanding of your needs, interests, and strengths.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 8 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:
Pronouns:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
Email Address *:

Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Campus Location(s)

Henniker Campus

Hybrid program

Low-residency program

Online (English language program)

Online (Spanish language program)
Additional Note:

Questions

Please list the specific housing/dining accommodation(s) you are requesting:
Please describe in detail what barriers to housing or dining you are encountering and how the request will help to remove those barriers:

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