Accommodation Request Form

* indicates a required field

Student Information

Semester

Year

First Name

Preferred Name

Middle Name

Last Name

Pronouns

R #

Please be sure to include all 9 characters, including the letter 'R'

Phone Number

Please use your university issued email address

Disability and Accommodation Information

My diagnosed disability falls into the following category

Please describe your disability and how it impacts you inside and/or outside of the classroom.

Did you receive accommodations in grade/high school?

What accommodations are you requesting?

Upload supporting document(s)

While you are a vital source of information, Accessibility Services may request documentation from a medical provider in order to establish a disability and the impact it has on living and/or learning in a postsecondary environment. If you have documentation regarding your disability, please upload it now. If not, you will be able to upload your documentation later. Please note that documentation is not required to begin the accommodation request process. If you need any assistance uploading documents or have questions regarding documentation, contact Accessibility Services at (407)975-6463 or access@rollins.edu.

Accommodation Request Form

Student Information

Disability and Accommodation Information

Document Information