Appeal letter sample: Private Dorm and Bathroom


Template letter for college students requesting dorm room accommodations. Healthcare provider completes letter requesting specific accommodations including single dorm room with a private bathroom in a residence hall. Letter is then provided to the patient's college or university.

SAMPLE LETTER BELOW

MM/DD/YYYY


Re:                  PATIENT NAME
DOB:              MM/DD/YYYY


Dear Sir or Madam:

Patient Name is a patient of mine at Location.   I follow Patient Name closely as she has inflammatory bowel disease, specifically recently diagnosed Disease.

I would like to ask that he/she be allowed to have a single dorm room with a private bathroom in a residence hall at School.   I believe a single room with the availability of a private bathroom would allow him/her the time to rest if his/her schedule allows, use the bathroom immediately when he/she has urgent, bloody, painful diarrhea and not disturb a roommate in the middle of the night when he/she needs to get up to move his/her bowels.  A single room would also allow him/her private time if he/she develops abdominal cramping or perianal pain.  He/She is likely to start treatment with immunosuppressant therapy and this may put him/her at an increased risk for infection so a single bedroom, hopefully with a private bathroom, would be ideal. 

Thank you for your consideration of this request.  This will greatly help Patient Name with his/her transition to college life as he/she faces a chronic illness while he/she adapts to a rigorous academic schedule.  Plus, a single dorm room will avoid the potential for disrupting a roommate. 

Please call my office at Phone Number, if you have any further questions.

Kind regards,

SIGNATURE



For further information, call CCFA at our Information Resource Center: 888.MY.GUT.PAIN (888.694.8872).

The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.

About this resource

By: CCFA
Published: May 1, 2012

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