Public Accommodation Request

* indicates a required field

Student Information

Please enter your information

First Name

Last Name

Middle Name

Preferred Pronouns

Student ID

This is the W# issued to each student by the university. If you do not yet have one, leave this item blank.

Please use your Wildcat Mail address (e.g., yourname@mail.weber.edu). Disability related materials can only be emailed to addresses issued by the university.

Birth Date

Phone Number

This may be a mobile number or landline, whichever is best for contacting you.

Accommodation Request

Instructions: Below, you will find a list of disabilities commonly recognized in the United States. The accommodation needs related to any given disability can vary significantly from student to student. Any information you can provide will clarify your specific needs and help to expedite the accommodation process.

Which of the following categories best identifies your disability?

If you are uncertain or unclear on this question, please enter your "best guess". You can indicate more than one disability if necessary.

Additional Disability Information

If your selection(s) above included "Specify", please identify the specific condition/disability.

How does your disability affect you academically or as a student in general?

Examples: Easily distracted when taking exams; Cannot read standard print textbooks; Writing assignments are difficult.

Please describe any accommodations you may require while attending WSU.

Semester

Year

Upload supporting document(s)

Please share information about your disability

This could be any form of documentation provided by your diagnostician or previous school.

It's not required but would be helpful and better when making contact with your advisor.

Public Accommodation Request

Student Information

Accommodation Request

Document Information