Public Accommodation Request

* indicates a required field

Student Information

Please bear with us as we transition to our new system. In order to be embedded, you must complete the form below.

Are you a student who needs to book a Testing Center appointment without registering with Disability Services? *

NOTE: If you are requesting Accommodations and want to register with the Disability Services office, select "No" for this question.

First Name *

Last Name *

Middle Name

Preferred Name

Student ID *

Email *

You must use your university issued email address

Preferred Phone Number *

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

Please prove you are not a robot