Student Accommodation Request Form

* indicates a required field

Student Information

Northwestern Health Sciences University grants reasonable academic accommodations to qualified applicants and students with disabilities on an individual basis. Individuals are provided reasonable academic adjustments and/or accommodations based upon specific information and assessment data documented by a qualified professional. Guidelines for the documentation of disabilities can be provided by the Disability Services office and are also located on our website. 

Students seeking temporary or ongoing disability accommodations must complete this form and submit documentation of their disability to the Disability Services Office. Students are additionally required to meet with the Director of Disability Services to develop an accommodations plan. Students are encouraged to meet with the Director of Disability Services ongoing throughout their enrollment to address in changes in accommodations that may be needed.

Please use your university issued email address
What is the best way to contact you?

University Status:

Are you an international student?

Specific Accommodation Information

Please describe how your condition(s) and/or disability substantially limits your current functioning in a major life activity (e.g. reading, walking, learning, speaking, writing, listening, etc.) and how your condition(s) and/or disability impairs your ability to take examinations (quizzes, exams, and practical examinations) under standardized conditions.

audio recorders, screen readers, audio books, speech to text etc.

Have you previously received accommodations/academic modifications?
How will you submit your documentation?Required
Documentation details:

Review documentation guidelines (pdf)

Upload supporting document(s)
STATEMENT OF CONSENT

I understand that if I request Disability Services to facilitate reasonable accommodations on my behalf, the Disability and Mental Health Program Manager may need to consult with other University personnel and share information about my condition as necessary.