Student Request for Accommodations Under the Americans with Disabilities Act

* indicates a required field

Student Information

If you believe you will require an accommodation to assist you in meeting your academic requirements, complete this form and it will be reviewed by the ADA Coordinator.

Important: You will also need to submit the appropriate, current, psychological evaluation or medical records that document your disability.

First Name

Last Name

Middle Name

Preferred Name

Student ID

Please use your Craven issued email address.

Phone Number

Specific Accommodation Information

Please describe your disability

Please describe the limitations or current impact imposed by your disability

Please list your requested accommodations

Upload supporting document(s)

Please submit the appropriate, current, psychological evaluation or medical records that document your disability.

Acknowledgement and Consent

Student Request for Accommodations Under the Americans with Disabilities Act

Student Information

Specific Accommodation Information

Document Information