Accommodation Request Form

* indicates a required field

Student Information

You will have as much time as you need to complete this form. However, if there is no activity on the form for 45 minutes, your session will end, and your information will be lost.

During this registration process, you will be asked to upload documentation of your disability.

Please use your HWS issued email address
Is this accommodation request for aRequired

Specific Disability Information

Please include any additional accommodation requests or other information that may be helpful for Disability Services staff to process your request.

Upload supporting document(s)

Documentation can be in the form of:

IEP, 504 Plan, Doctor's Note, Psychoeducational Evaluation, Etc. 

Please note: students requesting temporary accommodations or who do not have a diagnosis are not required to upload documentation with this form. However, documentation may be requested at the discretion of Disability Services in order to determine reasonable accommodations.

By signing my name below, I hereby give permission to Disability Services (CTL) to give/receive information related to my disability for the purpose of providing disability related accommodations. I have been told that in order to protect the limited confidentiality of records, my agreement to obtain or release information is necessary, and that this permission is limited to the purposes of ensuring access and accommodations.  I understand that by written statement, I may withdraw my permission at any time.  I also understand that I may ask to see the information that is to be sent.