The purpose of this online Accommodation Request Form is to allow individuals to request reasonable accommodations and to provide information necessary for the institution to evaluate the request in accordance with applicable laws and institutional policy. Information submitted through this form is used solely to determine eligibility for accommodations and to implement approved accommodations in a timely and appropriate manner. By submitting this form, you authorize the institution to review the information provided and to contact any medical providers, healthcare professionals, or other individuals identified as having supplied supporting documentation, for the limited purpose of verifying, clarifying, or supplementing information relevant to your accommodation request. Such contact will be limited to what is necessary to evaluate the request and will be handled confidentially in accordance with relevant privacy and record‑retention requirements. Submission of this form does not guarantee approval of an accommodation request. Additional documentation or information may be requested if needed to complete the review.
Please enter your CORE ID.
Please use your college issued email address (e.g. @commnet.edu OR @ctstate.edu).
I give the Connecticut State Colleges and Universities System Office permission to explore coverage and reasonable accommodations under the Americans with Disabilities Act of 1990, and all applicable State and Federal laws. I understand that all information obtained during this process will be maintained and used in accordance with the ADA, including its confidentiality requirements.