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Student Request for Accommodations Form

Submitting a Request For Accommodations Form does not guarantee that the accommodation will be granted. The student must also submit signed documentation from a licensed medical/mental health professional.  A thorough review of submitted documentation and a meeting with the Coordinator of SAS is necessary to determine whether the student would be considered a person with a disability at Delaware State University and what reasonable accommodations they may or may not qualify for. The requested accommodation needs to be specific to the functional limitations. 

Please submit documentation to verify your disability to be considered for accommodations. After the review of documentation, the next step is to schedule an appointment with the Coordinator of SAS.

Today's Date *
Name *
Date of Birth *
Please enter your unique D#. If you are a new freshman or transfer student, this will be found on your acceptance letter.
Please include your area code.
Enrollment Status *
What is/are the physical location(s) of the academic program or activity for which you are seeking accommodations? Select all that apply.
Location *
Select all that apply.
How would you classify your condition(s) or Impairment(s)? *
Is this condition temporary or permanent? *
What are the limitations associated with the previously listed condition(s)? *
Is this the first time you are requesting accommodations through Student Accessibility Services? *
Please detail any new accommodation requests you may have and/or any new condition you may be presenting at this time. New students - please list the accommodations your are requesting:
Please upload any documents that may assist in the application process.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx ppt pptx xls xlsx.