Accommodation Request

* indicates a required field

Student Information

This form is the correct place to begin requesting academic accommodations from Disability Support Services for the first time. If you have previously requested accommodations, and want to view them and associated materials, you should log into the SMCM Accommodate system. Within the system, you can complete a Semester Request to activate your accommodations for the current term.

First Name

Chosen Name

Last Name

Middle Name

Pronouns

SMCM Student ID

SMCM Email

All SMCM communication will be sent to a student's SMCM email account.

Personal Phone Number

Specific Accommodation Information

Below, you will find a list of disabilities. Because there can be significant nuance within each category of disability, it is important for you to help us understand the details of your condition as it affects your education. Please clarify the accommodations you are requesting.

My diagnosed disability falls into the following category

Select all that apply.

If "Other" diagnosed disability, please specify

Please describe your current disability. When, where, and by whom were you diagnosed?

Is this a temporary or permanent disability?

Select 'Temporary' to reflect short-term disabilities like broken bones and concussions.

Please describe how your disability or health condition creates barriers in your academic experiences.

Please describe how your disability or health condition creates barriers in your living situation (including dietary needs).

Please list accommodations you have received in K-12 to support your needs. If none, skip to the next field.

Please note that accommodations you may have received in high school may not necessarily be provided at the postsecondary level.

Please list accommodations you have received in a college setting to support your needs.

List the accommodations you are requesting at SMCM

If you have never received accommodations before or are unsure of what accommodations you need, you can put "I am not sure" in the field above.

Semester you're requesting this for:

Year you're requesting this for:

Accommodations for the Office of Residence Life

If "Other" Office of Residence Life accommodation, please specify

Upload supporting document(s)

If you do not have documents at this time, please continue with your request.

Accommodation Request

Student Information

Specific Accommodation Information

Document Information