Student Accessibility Accommodation Request Form

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Student Information

Please enter your information

Upload Supporting Documents

Note: In order to be approved for accommodations, adequate medical/psychological or educational documentation must be submitted. If this is your first time seeking accommodations, you may prefer to have your health care provider print and complete our Verification of Disability Form using the following link: https://regiscollege2-my.sharepoint.com/:b:/g/personal/cm102100_regiscollege_edu/EdSx5tEt3dFOizDABArHTAwB3gVz3vfkGNLv9G5eyYU8rg?e=vyu0nm

First Name

Last Name

Middle Name

Regis Student ID#

Regis Email Address

Phone Number

Please indicate where your classes take place:

Your diagnosed disability falls into the following category

Select all that apply:

How does your disability affect you academically and/or your life outside of the classroom?

What accommodations have you had in past educational settings?

What accommodations do you believe will be helpful during your time at Regis?

Please share any additional information below: