Public Accommodation Request

* indicates a required field

Student Information

Please enter your information below. Supporting documentation MUST be attached to the application at the time of submission. You will be prevented from submitting this request without the attached documentation.

Documentation verifies your eligibility for accommodations under Section 504 of the Rehabilitation Act, the Americans with Disabilities Act, and the ADA Amendments Act. Documentation commonly submitted includes, but is not limited to, IEPs and/or letters from treating physician/clinician. All documentation submitted is considered confidential. 

Documentation must be in .pdf or .doc file format.

In the event that you may not have access to a scanner or fax, you can utilize a free app that converts images into pdf files (eg., CamScanner).

Date of BirthRequired
Please format as (xxx) xxx-xxxx
Please use your university issued email address
{"display_name":"Classification","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Transfer StudentRequired
International StudentRequired
US VeteranRequired
Check appropriate category below.
{"display_name":"What is your current disability diagnosis? ","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Have you received accommodations from OASIS or the ESU Office of Disability Services in past semesters?Required

What type of accommodation are you requesting? You will be able to apply for both academic and housing accommodations in this form.

I am requesting Academic Accommodations.Required

The specific type of academic accommodation(s) you are requesting will be addressed below.

I am requesting Housing AccommodationsRequired

The specific type of housing accommodation(s) you are requesting will be addressed below.

I am requesting Temporary Accommodations.Required

Types of temporary accommodation(s) are parking requests and having a car on campus, for example.

Upload supporting document(s)Required

Please submit documentation as either a .pdf or .doc file.  No other types of file formats will be accepted. In the event that you may not have access to a scanner or fax, you can utilize a free app that converts images into pdf files (eg., CamScanner).