Accommodation Request Form

Student Information

IMPORTANT NOTE ABOUT HOUSING ACCOMMODATION REQUESTS: The priority deadline for housing accommodations was June 15th. Housing accommodations are based on availability. At this time, it is highly likely that if approved, Residence Life will NOT be able to implement until later in the semester or into the Spring semester.

CURRENT CMU STUDENTS: Please enter your information below. Students should be the one to complete this entire form, not their representative.

At the end of this form, you will be asked to provide documentation of your disability. It is helpful to have this documentation ready prior to beginning this form.

NOTE: This form times out after one hour. Please be sure to submit the form within one hour to avoid losing the info you have entered.

First Name

Middle Name

Last Name

Campus ID number (1234567)

CMU Global ID (smith1mv)

CMU Email

Please use your university issued email address (example: fireu1ch@cmich.edu)

Cell Phone Number

Date of Birth

Enrolled at CMU as

I was admitted to CMU as

Health and Accommodation Information

Please list your diagnosed conditions (include all that apply)

ex: Learning Disorder, ADHD, Epilepsy, Arthritis, Major Depressive Disorder, etc.

Current medications and/or treatment and side effects

History of accommodations and/or support services

Please include whether you had accommodations in HS, other colleges, etc. and what those accommodations were.

Did you receive any accommodations on a standardized test, such as ACT/SAT/LSAT/GMAT?

What disability-related accommodations are you requesting at CMU?

For a list of commonly requested accommodations, please visit our website.

Impact

Describe how your disability impacts you.

Free Response

Is there anything else you want us to know?

Please include anything about yourself not covered here or in the documentation you submit.

Consent to Release & Documentation

SDS staff may find it helpful to consult with others about your disability and request for accommodations. To grant permission, check “Yes” and list the names of the individual(s) in the field.

Parent(s)/Legal Guardian(s)

Parent(s)/Legal guardian(s) Name

Diagnostician who diagnosed the disability

Diagnostician Name

Other medical professionals

Name(s) of other medical professionals

Consent for Services

Your confidentiality is important to us. Please be advised that FERPA does allow us to share information within CMU with other employees who have a legitimate educational interest in the information. For example, if you are requesting a housing accommodation, we will be in communication with Residence Life.

Upload supporting document(s)

If you do not have your documentation ready to submit now, you will need to email it to SDS@cmich.edu once you have it.

Include all medical and psychological documentation, school records (high school or other college accommodation plans), or reports. Failure to submit all available records may delay your request. Review our documentation guidelines for more details.