Public Accommodation Request

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Student Information

Please enter your information
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(Begins with an "A" and is followed by nine numbers, you can complete this form once a student ID number has been created for you)
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(SRU email REQUIRED)
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(Area Code) XXX - XXXX

Specific Accommodation Information

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Please describe the accommodations you are requesting at this time. Accomodations will be discussed in your welcome meeting. All accommodations are assigned on a case-by-case basis.
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See documentation guidelines. Photos of documentation will NOT be accepted. Please scan and attach, or fax to 724.738.4399
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By typing my initials in the box below, I authorize the Office of Disability Services at Slippery Rock University to disclose educational, psychological, and medical records or information that would assist the university in the design of reasonable accommodations to my disability.  

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By typing my initials in the box below, I authorize the Office of Disability Services at Slippery Rock University to receive educational, psychological, and medical records or information that would assist the university in the design of reasonable accommodations to my disability.