Accommodation Request Form

Submit your disability accommodation request with Student Disability Services using the form below. Note that all fields marked with a red asterisk(*) are required fields.

Please submit supporting documentation with this form for disability and accommodation determination by sending an email to kendalls@stedwards.edu or fax to Kendall Swanson at 512-464-8830. If you have further questions refer back to Students with Disabilities.


First Name:*   
Last Name:*   
Email Address:*   
Company:  
Phone:  
 
Course(s) Name(s):*   
 
Course(s) Date(s):*   
 
Are you working with the Department of Assistive and Rehabilitative Services? If so, provide your DARS Counselor's name and phone number.  
 
List your diagnosed disabilities:  
215 characters remaining
Describe your disability and how it impacts your class performance:  
215 characters remaining
Describe any classroom accommodations you have received in the past and think you need for this course:  
215 characters remaining
List anything else you would like your disability counselor to know about your disability:  
 
Validator:*   
Write the letters from the image in the space provided:
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