Public Accommodation Request

Student Information

Please enter your information

Date

First Name

Last Name

Middle Name

Date of Birth

Student ID

Email

Please use your university issued email address

Phone Number

Major

Are you a veteran?

Are you a client of Vocational Rehabilitation?

Are you Deaf or Hard of Hearing?

Are you currently enrolled?

What semester are you requesting accommodations to begin?

Accessibility Specific Information

Briefly describe why you are contacting Accessibility Services

Disability Category

Check all that apply

What is your formal diagnosis?

Specific Accommodation Information

Parking Accommodations:

To request accessible parking, please submit a state-issued accessible parking permit to UVU Parking Services. State-issued accessible parking permits must be obtained through a state authorized agency. The Office of Accessibility Services does not handle parking-related requests.

Describe the functional limitations caused by your disability and how these limitations impact you in an academic setting:

Please list the accommodations that you feel are necessary to allow you to access our curriculum and campus:

Please describe how each accommodation relates to the functional limitations of your disability

Do you or have you used any adaptive technology or devices? If so, please describe what has been the most helpful:

Other Information

Please include anything else you would like OAS to know in order to best assist you:

Please list any questions you have about our services that we can answer for you:

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