Public Accommodation Request

* indicates a required field

Student Information

Please enter your information
(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)
(SRU email REQUIRED)
(Area Code) XXX - XXXX
Enrollment StatusRequired
Have you previously received accommodations?Required
Are you working with the Office of Vocational Rehabilitation (OVR) or another vocational rehab office?Required
Are you working with Veteran's Affairs?Required
Are you requesting a housing accommodation?Required
Are you requesting an emotional support animal (ESA) to reside on campus with you?Required
Are you a student who has been accepted into the Rock Life Program?Required

Specific Accommodation Information

My diagnosis falls into the following category/categoriesRequired
ADD / ADHD
Autism
Emotional / Psychological
Emotional / Psychological: Anxiety
Emotional / Psychological: Bipolar
Emotional / Psychological: Depression
Emotional / Psychological: OCD
Emotional / Psychological: Other
Emotional / Psychological: PTSD
Hearing
Learning
Learning: Math
Learning: Other
Learning: Reading / Dyslexia
Learning: Writing
Medical Health
Medical Health: Arthritis
Medical Health: Cancer
Medical Health: Cardiac Disease
Medical Health: Diabetes
Medical Health: Epilepsy
Medical Health: Other
Physical / Mobility
Temporary Disability (6 months or less)
Temporary Disability (6 months or less):
Temporary Disability (6 months or less): Concussion
Temporary Disability (6 months or less): Injured Arm / Hand
Temporary Disability (6 months or less): Injured Leg
Temporary Disability (6 months or less): Other
Traumatic Brain Injury
Undisclosed
Visual
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.
Semester and Year (Ex. Fall 2023)
Upload disability support document(s)
See documentation guidelines on our website at www.sru.edu/ods. Photos of documentation will NOT be accepted. Please scan and attach, or fax to 724.738.4399

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.  

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.