• Disability Self-Disclosure Form

  • Required of students requesting academic accommodations. 

  • If you are a student with a disability and wish to request accommodations, please complete this form. You also must provide documentation of your disability as detailed on the College website. All documentation will be kept confidential and maintained separately from your student academic record. 

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  • Students must complete this form and provide current, detailed documentation before accommodations can be provided. I hereby authorize the Director of Counseling, Health and Disability Services to disclose information about my accommodation needs to my faculty and personnel directly involved in providing academic, residential or support services. I understand that Hiram College reserves the right to request additional or more current documentation in order to identify a disability and/or appropriate accommodations. 

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  • Questions: 330-569-5418 (office), 330-569-5398 (fax), feisthamelkp@hiram.edu (email) 

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