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.

* indicates required field

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