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ODR Accommodation Request Form
Home
Student Life
Office Of Disability Resources
ODR Accommodation Request Form
ODR Accommodation Request Form
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ODR Accommodation Request Form
Please fill out the form fields below. Contact the admissions team with any questions.
ODR Accommodation Request Form
Please don't fill out this input box.
Date
*
Term
*
First Name
*
Last Name
*
Date of Birth
*
(mm/dd/yy)
Email Address
*
(Please list BAC email if you are a current student)
What is your enrollment status?
*
Prospective Student
Undergraduate Student
Other
What is your major or program of study?
Year in School
Freshman
Sophomore
Junior
Senior
Other
How would you classify your condition(s) or impairment(s)?
*
Brain Injury
Chronic Health Conditions
Learning Disability
Psychiatric Impairment
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder
Hearing Impairment
Physical/Mobility Impairment
Visual Impairment
Other
Please select all that apply
This condition is
*
Temporary
Permanent
If temporary, please indicate the expected time required for recovery
What are the limitations associated with the above condition(s)?
*
Seeing
Hearing
Breathing
Eating
Sitting
Sleeping
Fatigue
Reading
Thinking/Concentrating
Functioning of a Major Body Organ or Operation
Lifting
Walking/Climbing Stairs
Fine Motor Control
Standing
Other
Please select all that apply
Is this the first time you are requesting accommodations through the Office of Disability Resources?
*
Yes
No
Please detail any new accommodation requests you may have and/or any new condition you may be presenting at this time.
*
New students- please list the accommodations you are requesting
Have you previously received an Accommodation Verification Letter (AVL) and are you now requesting new accommodations?
Yes
No
Form UUID
Site Name
Submit
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