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WSSU: Student Accommodations Request Form

Winston-Salem State University is committed to compliance with the Americans with Disabilities Act (1990) the American with Disabilities Amendments Act (2008), and Section 504 of the Rehabilitation Act (1973). The purpose of this form is to assist Winston-Salem State University in determining whether, or to what extent, a reasonable accommodation may or may not alter the essential criteria of a course or program of study.

This form is to be completed by the Winston-Salem State University student that is seeking accommodations through the WSSU Department of Disability Services.

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