WSSU: Student Accomodations Request Form

This form is to be completed by the WSSU Student that will receive assistance through the Department of Disability Services.

Place a check mark inside each check box to affirm the following:

	1.	I certify that I am the student requesting services through the Department of Disability Services.
	2.	I certify that I am initiating a disability eligibility review.
	3.	I understand that the documentation for reasonable accommodations varies based on the disability and circumstances (essential functions/criteria), and that I am responsible for verifying what documentation is needed.
	4.	I understand that I am responsible for all cost associated with obtaining the reports, examinations, tests, etc.
	5.	I understand it is my responsibility to share comprehensive and appropriate documentation to the Department of Disability Services.