Accommodation Request Form

* indicates a required field

Student Information

Student Accessibility Services appreciates you taking the time to complete this form.

The background information you share and documentation you provide are part of the interactive process used to understand your needs and determine reasonable accommodations.

Once this form is received, our office will contact you to let you know the next steps.

We are excited to work with you!

First Name

Last Name

Pronouns

W ID#

ex W00000000

Please use your WIT issued email address

Year in school

Specific Accommodation Information

Diagnosis/disability you are seeking accommodations for:

Which area are you seeking accommodations? Please explain how your diagnosis impacts you. Mark all that apply.

Classroom

Testing

Housing

Other

Are you requesting specific accommodations? If so, please describe.

Have you received accommodations in the past? (This will not affect your eligibility).

Upload supporting document(s)