Request for Accessible Educational Services

Student Information

First Name

Middle Name

Last Name

Preferred Pronouns

What is your date of birth?

Email

Please use your university issued email address, if you have one.

Phone Number

Please tell us the best number to reach you.

Do you have a university student ID number?

Please select your primary IU campus

Why are you requesting services?

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Support Services Request

Have you received academic accommodations in another setting?

Please describe your accommodation needs.

Do you need accommodations for New Student Orientation?

Do you use a service dog?

Housing Accommodation Only - Do you have an emotional support animal?

Do you receive Vocational Rehabilitation (VR) funding?

Medical Information

What is your qualifying condition?

Please describe how your condition impacts your educational experience

Supporting Documentation

Upload supporting document(s)

Please attach documentation verifying your need to testing modifications or accommodations. See our website for details about acceptable forms of documentation. You may submit this later if documentation is not currently available, but please note your request will not be processed until appropriate documentation is received.

Maximum upload size per file is 3MB.

Additional Information