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Accommodation Request
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indicates a required field
Student Information
Please enter your information
First Name
Required
*
Last Name
Required
*
Middle Name
Preferred Name
Pronouns
Student ID
Required
*
Email
Required
*
Please use your college issued email address
Phone Number
Required
*
Class Year
Required
*
Specific Accommodation Information
My disability falls into the following category
Required
*
[select]
Allergy
Chronic Illness
Developmental
Learning
Physical
Psychological
Sleep
Undiagnosed
Other
clear
{"display_name":"My disability falls into the following category","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Specific Diagnosis
Request for
Required
*
Request for
New Issue
Request for
Ongoing Issue
Request for
Emergency Issue
Type of Accommodation
[select]
Academic Accommodation
Concussion Accommodation
Emotional Support Animal Accommodation
Housing Accommodation
Other
Recent Injury Accommodation
clear
{"display_name":"Type of Accommodation","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Please provide details explaining your need for accommodation(s) and indicate the accommodation(s) you are requesting.
Please list here the name of a Dean or other staff member who is working with you regarding this accommodation (if any)
Additional information you want to share
Upload supporting document(s)
The rationale for seeking information from a healthcare provider about a student’s condition is to support OAE in establishing disability, understanding how a disability or disabling condition may impact a student, and making informed decisions about accommodations. Ensuring that a specific accommodation or accommodation plan provides effective access requires a deliberative and collaborative process that is responsive to your experience under the guidance of the ADA and its Amendments. The documentation you provide will assist our efforts to engage in a structured exchange with you to explore previous educational experiences, past use of accommodations, and what has been effective and ineffective in providing access. It can be possible to evaluate whether a requested accommodation is reasonable or not with minimal reliance on external documentation but this is done on a case by case basis.
Document Information
Document Title
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*
File
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Maximum file size: 10240kb
Description