Public Accommodation Request

* indicates a required field

Student Information

In order to receive academic accommodations, please fill out the form below and attach documentation. We review documentation on Wednesdays as a team.

This process is only for academic accommodations. This form is not appropriate for the following:

Housing for Medical Reasons
Meal Plan Requests
Medical Withdrawal/Incomplete grades
Transportation concerns
Parking concerns

This form must be filled out by the student only, otherwise it will be rejected, delaying the application process as the student will be asked to fill out the form again.

Can be different from your chosen name
You must use your UMass Lowell issued email address
I am only requesting access to book exams in the Testing Center. I am not requesting disability accommodations at this time.Required
NOTE: If you are requesting Accommodations and want to register with the Disability Services office, select "No" for this question.
Please note if you are visiting student for that semester only
Are you registering for a temporary disability that is expected to last less than 6 months (e.g recent concussion, broken limb)?Required

Specific Accommodation Information

(Not applicable for those who are only requesting access to the Testing Center)
My diagnosed disability(ies) falls into the following category(ies)Required
Select all that are diagnosed

For example

  • Additional support services used in the past (i.e. aide)
  • Needed campus resources (i.e. writing support, tutoring, etc.)

Functional Limitations

Please select any of the major life activities that you feel are significantly impacted by your disability.
Functional LimitationsRequired
Please select all that apply
Did you attend a college or university prior to UML?Required

ex: Fall 2015-Summer 2018

Upload supporting document(s). See website for documentation requirements

Please attach documentation if available. Documentation can also be provided by email. The process will not move forward until documentation is received. Documentation Guidelines.

The Disability Services Office provides academic access to students, therefore the following forms do not fall under the purview of the Disability Services office. These forms WILL NOT be reviewed if submitted here:

Housing for Medical Reasons
Meal Plan Requests
Medical Withdrawal forms

Please refer to these forms for the process on how to submit them.

Do you require elevator access due to a disability? (even if only sometimes)Required
By checking yes to this box, we will be sending you an email when we are notified that there is an elevator outage.
Would you like us to be able to share your connection to Disability Services with your success team (i.e. academic and professional advisor, cohort advisor, etc.)?Required
This will give your advisor more information when helping you pick your classes and create your schedule.
By checking this box, you confirm that you are the student named above and you have filled this form out on your own behalf.Required