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

Are you a student who needs to book a Testing Center appointment without registering with Disability Services?Required
NOTE: If you are requesting Accommodations and want to register with the Disability Services office, select "No" for this question.
Are you registering for a temporary disability that is expected to last less than 6 months (e.g recent concussion, broken limb)?Required
You must use your UMass Lowell issued email address

Specific Accommodation Information

Functional Limitation

Please select the extent to which you believe your diagnosed condition affects the following major life activities.
Did you attend a college or university prior to UML?Required
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.

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