Student Accommodation Intake Form

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Student Information

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Please use your university issued email address
Date of birth Required

Specific Accommodation Information

Purpose for Accommodation RequestRequired

Documentation requirements

Students who seek support services from Accessibility Services are required to submit current documentation to verify eligibility as defined under section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Protection under these civil rights statutes is based upon documentation of a disability that currently substantially limits at least one major life activity.

*Ask CASAS staff for a detailed copy of the documentation guidelines or download a copy at

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