• Disability Accommodations Application

    This form should be completed if you are requesting an accommodation due to a disability or temporary injury/illness. This form does not guarantee approval of the requested accommodation, but rather initiates the request review process with the Disability Support Services office. All accommodations require appropriate and timely documentation and are evaluated and determined on a case-by-case basis.
  • Type of request:*
  • What type of Accomodations are you requesting?*

  • Indicate the type of accommodation(s) you are requesting:*

  • Indicate the accomodation you are requesting:*

  • Documentation

    In order to request or renew accommodations, appropriate documentation must be provided. Please complete the information below and upload the appropriate documentation, if available.
  •  -
  • Do you have additional licensed professionals who you see consistently concerning the mentioned condition(s)/injury?
  • Date of initial diagnosis
     - -

  • Approved forms of documentation are:

    • High school IEP
    • Licensed medical professional letter (license/field must be appropriate to the diagnosis)
    • Licensed Professional Counselor letter (license/field must be appropriate to the diagnosis)

    For the letter from your physician or counselor to be considered an approved form of documentation, you must be currently under that physician and/or counselor's care for the condition you are requesting accommodation for. The physician and/or counselor letter must detail the following:

    • the disability, illness, condition or temporary ailment/injury requiring accommodation
    • its symptoms that hinder one or more major life functions
    • how the symptoms inhibit the student from academic engagement
    • the treatment plan in place to manage symptoms and expected outcome of that plan
    • the specific accommodation(s) needed as part of the treatment plan
  • Indicate what type of documentation you will be providing or have already provided to the Disability Support Services office:*
  • Browse Files
    Cancelof
  • Animal Type:*

  • Animal Gender:*
  • Most recent Rabies & other Required Vaccination Date:*
     - -
  • Date of last visit/health check-up*
     - -
  • Is the animal spayed/nuetered?*
  • Browse Files
    Cancelof
  • Should be Empty: