Initial Information Form

* indicates a required field

Student Information

Please enter your information

First Name

Preferred Name

Please make sure to review WMU Preferred name processes to use a preferred name at the University.

Last Name

Middle Name

WIN (Western Identification Number)

Use your 9-digit Student ID number (example: 123456789)

Re-enter your WIN (Western Identification Number)

Birthday

WMU Email

Please use your university issued email address (example: buster.b.bronco@wmich.edu)

Cell Phone Number

Disability Information

What is your diagnosed disability?

Do you use assistive technology?

How does your disability affect you academically?

Upload supporting document(s)

If you have documentation, such as IEP, 504 plan, medical information, psychological evaluation or other information concerning you disability, please upload it now.