Student Accommodation Request

Student Information

Please enter your information

Start Term

Student ID *

First Name *

Last Name *

Preferred Name

Email *

Please use your university issued email address

Phone Number *

Affiliations

Are you registered with ACCES-VR?

Will you be living on campus? *

Are you registered to vote?

Disability Information

Documented Disability

Please pick all documented disabilities that apply

Upload supporting disability documentation

If you would like to submit your documentation online, please upload here.

Specific Accommodation Information

What academic accommodations have you received in the past? *

What academic accommodations are you requesting at New Paltz? *

Release of Information

Please list the name(s) of any individual(s) (and their relationship to you) that you would like the DRC to have permission to speak to on your behalf.

Agreement Statement

By typing my first and last name here:

I understand that the DRC has my permission to share my accommodation information with other SUNY New Paltz departments and faculty members for the purpose of helping me to succeed.

I recognize that it is my responsibility to submit a semester request in the beginning of each semester.