Public Accommodation Request

* indicates a required field

Student Information

Please enter your information
Please enter like this example: 123-456-7890
Are you a veteran?

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of accommodations needed can vary significantly. Below, you will find descriptions of the various types of disabilities recognized in the United States. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular accommodations she or he requests
{"display_name":"Secondary (other) diagnosed disability(ies):","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
What accommodations are you requesting?
Does the impairment substantially limit a major life activity as compared to most people in the general population?Required
Upload supporting document(s) here. If you don’t have documents at this time, complete the form and submit.

Appointment Scheduling

Provide three dates and blocks of times you’re available for a 30-minute appointment, excluding today.
Appointments are Monday through Friday, 8:30am – 3:00pm. Excluding the lunch hour.