Request for Disability Support Services Form

* indicates a required field

Student Information

*
*

Please let us know if you typically go by something other than your legal name. We encourage you to register your preferred name with IU.

*
*
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) *
*
[select]

Support Services Request

Type of Accommodations needed(Required) *
Check all that apply.



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

Medical Information

*
[select]
*
Do you use a service dog?
Do you have an emotional support animal?

Supporting Documentation

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

*