Public Accommodation Request

* indicates a required field

Student Information

If you have a 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: Residence Life manages all housing accommodations (with the exception of ESA requests).

This form should be completed 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 Access Services website. You may also contact us at ASC@austincollege.edu or call (903) 813-2454.

First Name

Last Name

Middle Name

Student ID

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

Please 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 asc@austincollege.edu

or mail to:

Academic Skills Center

900 North Grand, Suite 61544

Sherman, TX 75090

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Public Accommodation Request

Student Information

Specific Accommodation Information

Document Information