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Students with Disabilities Requesting Accommodations Application

Two easy steps to register
This form should only be used for academic accommodation requests. Students requesting housing accommodations should complete the application here: Housing Accommodation Application.

Students who have already registered for disability services at the University of Rochester should use the DR Student Portal to make additional requests.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Please select campus location where you will be enrolled.
  3. Note: Select when you plan to graduate.
  4. Hint: Enter 8 numeric characters, not your net ID.
  5. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)


    Autism Spectrum Disorder

    Basic Chronic Medical Condition


    Complex Chronic Medical Condition

    General Category


    Learning Disability

    Mental Health





    Traumatic Brain Injury


  2. Affiliation(s)
Please select accommodations and services that you have received prior to registering with our office. This can be accommodations and services provided at your High School or other College/University. If there are none, or if you are requesting temporary services, please leave any selections blank.

Prior Accommodations Used

Alternative Testing
Alternative Formats
Communication Access
Classroom Access
Notetaking Technology
Please select services you are requesting from our office. Any accommodations requested are not guaranteed; you must provide documentation that supports your need for these accommodations.

Accommodations You Are Requesting

Alternative Testing
Alternative Formats
Communication Access
Classroom Access
Notetaking Technology
    Please tell us more about what you are seeking. * (Selection is Required)
    In your own words, please describe your disability barriers. * (Selection is Required)
    Would your disability hinder you from evacuating a building in an emergency? * (Selection is Required)
    Does your condition affect your transportation needs? If so, please explain. * (Selection is Required)
    Do you anticipate using auxiliary aids, assistive technology, and/or other services while attending the University of Rochester (e.g. software, service dog, wheelchair)? * (Selection is Required)
    Please review our documentation guidelines and submit appropriate documentation for your disability barriers. Please indicate how we should expect to receive your documentation. * (Selection is Required)
    By submitting this form, I certify that the information provided on this form is accurate. I understand that to be eligible for access accommodations at the University of Rochester, I must 1) submit this completed form, 2) submit disability documentation that substantiates the requested accommodations, and 3) participate in an initial individual assessment with a disability services professional. * (Selection is Required)
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