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Accommodation Request
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Student Information
Please enter your information
First Name
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Last Name
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Middle Name
Student ID
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Email
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Enter your university email address.
Phone Number
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Preferred Pronoun
He, Him, His
She, Her, Hers
They, Them, Theirs
Xie, Xy, Xem
Other
Campus
Campus
IUPUI
IUPUC (Columbus)
IU Fort Wayne
IUPUI/Butler Dual Degree
Please list any other colleges or universities where you previously received accommodations.
Are you currently a client of Indiana Vocational Rehabilitation (Voc Rehab)?
Required
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Are you currently a client of Indiana Vocational Rehabilitation (Voc Rehab)?
Yes
Are you currently a client of Indiana Vocational Rehabilitation (Voc Rehab)?
No
Will you be living in university housing in the coming/current year?
Required
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Will you be living in university housing in the coming/current year?
Yes
Will you be living in university housing in the coming/current year?
No
Will you be a student in the IU School of Medicine?
Required
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Will you be a student in the IU School of Medicine?
Yes
Will you be a student in the IU School of Medicine?
No
Will you be a student in IU's School of Dentistry?
Required
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Will you be a student in IU's School of Dentistry?
Yes
Will you be a student in IU's School of Dentistry?
No
Will you be a student in the McKinney School of Law?
Required
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Will you be a student in the McKinney School of Law?
Yes
Will you be a student in the McKinney School of Law?
No
Specific Accommodation Information
Specific Diagnosis
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Enter a specific diagnosis (or diagnoses)
How does your disability affect your academic experience and your life in general?
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What accommodations are you requesting?
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Please upload any supporting documents using the secure uploading utility.
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If your documentation comes directly from your medical provider or if you do not have access to your documentation, please contact our office at 317-274-3241 or aes@iu.edu.
Document Information
Document Title
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File
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