Public Accommodation Request

* indicates a required field

Academic Accommodations Request

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. 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 jreed@austincollege.edu or call (903) 813-2548.

Please note: The Office of Student Life manages all Housing Accommodations and will require a different form.

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? What accommodations have you used previously?

How and when was your disability diagnosed and documented?

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

Upload supporting document(s)

If you are unable to add documentation at this time, please contact jreed@austincollege.edu or 903-813-2548.

Public Accommodation Request

Academic Accommodations Request

Specific Accommodation Information

Document Information