Public Accommodation Request

* indicates a required field

Student Information

If you have a documented disability, please complete the following questions so that Access Services at Austin College will have an idea of the services you may need. Please note: Student Life manages all housing accommodations.

This form should be completed ONLY by the student. All information disclosed on this form will be kept confidential and will be shared with appropriate college personnel on a need-to-know basis.

For more information about disability services, please visit the CSSAS website. You may also contact us at CSSAS@austincollege.edu or call (903) 813-2548.

First Name

Last Name

Middle Name

Student ID

Please enter your 7-digit student ID, including the leading 0.

ONLY use your Austin College issued email address.

Phone Number

Please provide the student's phone number.

Specific Accommodation Information

What is the nature of your disability?

How does your disability affect you academically?

How and when was your disability diagnosed and documented?

What accommodations have you used previously?

Please describe below.

What accommodation(s) are you requesting at Austin College?

Upload supporting document(s)

If you are unable to add documentation at this time, please send your documentation to:

email:

jreed@austincollege.edu

in person:

CSSAS - Wright Campus Center, Room 211

900 North Grand, Sherman, TX 75090

fax:

903-813-2038

Public Accommodation Request

Student Information

Specific Accommodation Information

Document Information