Disclosure and Request for Accommodations

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Student Information

This form is for new and current Elon University students who are requesting initial accommodations. The form MUST BE completed by the student.

First Name

Last Name

Middle Name

University ID

7-digit number that can be found under My Profile in On Track.

Student Type

Elon Email

Please use your university issued email address

First semester of enrollment

Please enter your first semester of enrollment at Elon University. If you are an incoming student, please enter your first anticipated semester (for example, Fall 2021).

Phone Number

Specific Accommodation Information

Type of Disability

Upload supporting document(s)

My diagnosed disability falls into the following category:

How does your disability affect you academically?

How does your disability affect student life in general, like taking tests and studying?

What accommodations have you needed in the past?

What accommodations do you think you will need at Elon?

Are you requesting a housing-related accommodation? If yes, please make sure you and your provider have completed and submitted the housing accommodations request packet (found on the DR website).

In the event of an emergency, I will need assistance.

DRO will provide student information to Residence Life and Campus Safety in order for university personnel to assist you in emergency situations.

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Disclosure and Request for Accommodations

Student Information

Specific Accommodation Information

Document Information