Request for Accommodations Form

Complete and submit this form in its entirety.

I have reviewed the Rights and Responsibilities. My submission of this form signifies I have read and agree to my Rights and Responsibilities.

If you are requesting an Emotional Support Animal (ESA) as an accommodation, please go to the ESA request form.

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All official University business will be conducted via MSUM email accounts. It is essential that you access, read and use your account.

Are you living on campus?*
Reason for applying:*

Diagnostic Information

Please identify any disability/disabilities that you have been diagnosed with:*

History of Accommodations

Documentation from a qualified professional must be shared with Accessibility Resources.

If you do not receive a copy of this form in your email that this form was submitted successfully, please contact the Accessibility Resources Office.