Public Accommodation Request

* indicates a required field

Student Information

Please enter your information
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Birthday(Required) *
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Please use your university issued email address
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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.
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You may select as many disabilities with which you identify
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What accommodations are you requesting?(Required) *

Accommodation

Have you received accommodations in the past?(Required) *
If you have documentation, such as IEP, 504 plan, medical information, psychological evaluation or other information concerning you disability, please upload it now.