Intake Form

* indicates a required field

Student Information

Please enter your information
Are you already receiving services with the DRC?Required
Please use your university issued email address

Academic Information

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Disability and Accommodation Information

Have you previously received accommodations from the Disability Resource Center?Required
{"display_name":"Please select your primary disability(ies)","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
{"display_name":"Please select your secondary disability(ies)","hidden_field_name":"ms_field_3","init_id":"ms_field_3","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
{"display_name":"Please select your tertiary disability(ies)","hidden_field_name":"ms_field_4","init_id":"ms_field_4","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Temporary or Long-TermRequired
Is this a temporary injury or long-term disability related accommodation request?
I will require the following to be present for my meeting with the DRC:
Upload supporting document(s)

Please upload all medical documentation that supports your requests for accommodations.
If you do not have documentation, please download the DRC Physician Form to bring to your physician to complete. 

Questions/Concerns

If you have any questions or concerns, please email the DRC at drc@emich.edu for a quick response!