Public Accommodation Request

* indicates a required field

Student Information

If you are taking Summer classes, we will reach out to you ASAP to register you with our office.

For students starting in Fall 2020, we are holding off on intake appointments until we have more understanding of what fall will be like, but we will be complete it over the summer. Please be sure to check your student email.

First semester at UMass Lowell (e.g. Fall 2019) *

First Name *

Last Name *

Middle Name

Preferred Name

Student ID *

Email *

You must use your university issued email address

Preferred Phone Number *

Specific Accommodation Information

My diagnosed disability falls into the following category *

If you selected "other" for the previous question, please specify

What Accommodations have worked for you in the past? *

Please list any disability medication you are currently taking.

How does your disability affect your daily life? *

How does your disability affect you academically? *

Please share any other information that you feel would be helpful to SDS.

Functional Limitation

Please select the extent to which you believe your diagnosed condition affects the following major life activities.

Caring for oneself *

Talking *

Hearing *

Breathing *

Seeing *

Walking/Standing *

Lifting/Carrying *

Sitting *

Performing Manual Tasks *

Eating *

Working *

Learning *

Reading *

Writing/Spelling *

Calculating *

Memorizing *

Concentrating *

Listening *

Other

Did you attend a college or university prior to UML? *

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
Animal Request Forms
Meal Plan Requests
Medical Withdrawal forms

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

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