Public Accommodation Request

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Student Information

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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)

Birthday

WMU Email

Please use your university issued email address

Cell Phone Number

Military Status

Are you active military or a veteran?

Service Agencies

Are you a client or receiving services from any State or Federal Agency?

Disability Information

Instructions: There is much variability within each disability 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 disability.

My diagnosed disability falls into the following category

You may select as many disabilities with which you identify

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.

Public Accommodation Request

Student Information

Disability Information

Document Information