Intake Form

* indicates a required field

Student Information

Please enter your information
Are you already receiving services with the DRC?Required

Please write your full number, including the capital E. 
Example: E0012345

Please use your university issued email address to avoid delays in processing your request.

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 all diagnoses that impact you","hidden_field_name":"ms_field_2","init_id":"ms_field_2","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. 


If you have any questions or concerns, please email the DRC at for a quick response!