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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.
  8. Hint: Enter 8 numeric characters, not your net ID.
  9. 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
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
  4. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  2. Secondary Disability(ies)

    ADHD

    Autism Spectrum Disorder

    Basic Chronic Medical Condition

    Communication/Speech

    Complex Chronic Medical Condition

    General Category

    Hearing

    Learning Disability

    Mental Health

    Mobility

    Motor

    Orthopedic

    Temporary

    Traumatic Brain Injury

    Vision

  5. 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
Deaf and Hard of Hearing
Classroom Access
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
Deaf and Hard of Hearing
Classroom Access
Questions
  1. Please tell us more about what you are seeking.*
  3. In your own words, please describe your disability.*
  4. Would your disability hinder you from evacuating a building in an emergency?*
  5. Does your condition affect your transportation needs? If so, please explain.*
  6. Do you anticipate using auxiliary aids, assistive technology, and/or other services while attending the University of Rochester (e.g. software, service dog, wheelchair)?*
  7. Please review our documentation guidelines at http://www.rochester.edu/disability/documenting.html and submit appropriate documentation for your disability.*
  8. 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.*
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