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Student Accessibility Accommodation Request Form
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Student Information
Please enter your information
First Name
(Required)
*
Last Name
(Required)
*
Middle Name
Student ID
(Required)
*
Email
(Required)
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Please use your university issued email address
Phone Number
(Required)
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Please indicate where your classes take place:
(Required)
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Please indicate where your classes take place:
Weston
Please indicate where your classes take place:
Regis North (Lawrence)
Please indicate where your classes take place:
Regis Online
Specific Accommodation Information
My diagnosed disability falls into the following category
(Required)
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How does your disability affect you academically?
(Required)
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What accommodations have you had in past educational settings?
What accommodations do you believe will be helpful here at Regis?
How does your disability affect student life in general, like taking tests and studying?
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