Request for Disability Support Services Form

To request services and accommodations at Indiana University Bloomington, please complete and submit the form below.
* indicates a required field

Student Information

Please let us know if you typically go by something other than your legal name. If you do not, please re-enter your first name.

What is your date of birth?Required
Please use your IU Bloomington email address, if you have one.
Please tell us the best number to reach you.
Do you have an Indiana University student ID number?Required
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Support Services Request

Type of Accommodations neededRequired
Check all that apply.

Date of orientation check-in
Have you received academic accommodations in another setting?Required

Medical Information

{"display_name":"What is your qualifying condition?","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Do you use a service dog?
Do you have an emotional support animal?
Do you receive Vocational Rehabilitation (VR) funding?Required

Supporting Documentation

Upload supporting document(s)

Please attach documentation verifying your need to testing modifications or accommodations. See our website for details about acceptable forms of documentation. You may submit this later if documentation is not currently available, but please note your request will not be processed until appropriate documentation is received.

Maximum upload size per file is 3MB.

Additional Information

Would you like to receive text messages from our office about your accommodation(s)?Required