Self Disclosure Form

* indicates a required field

Student Information

Please enter your information

Please use your university issued email address

Specific Accommodation Information

This could be related to housing, food, social life, day to day activities, etc.
What type of accommodations are you requesting?Required

Please select all that apply






Upload supporting document(s)

General criteria for documentation includes the following:

1) The documentation must be prepared by a professional (unrelated to the student) who is licensed to practice within a field directly related to, and associated with, the student’s condition.

2) Be printed on either official stationery and include printed name, contact information, and signature of the provider.

3) Include a current, original statement of diagnosis identifying the disability and describe by what means the condition was diagnosed.

4) IEP and 504 plans provide helpful contextual information about previous experience, but do not constitute documentation for the purposes of establishing reasonable accommodation.

If the supporting documentation submitted is not adequate to validate the existence of a disability, the Director of Student Disability Services reserves the right to request updated assessments or additional evaluations.