Public Accommodation Request

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Student Information

Please enter your information
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Date of Birth(Required) *
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Please use your university issued email address
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Academic Information

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Enrollment Status(Required) *



Are you a student athlete?(Required) *

Accessibility Specific Information

Instructions: There is much variability within each accessibility category, and therefore, the type of accommodations needed can vary significantly. Below, you will find descriptions of the various types of disabilities recognized in the United States. Student needs vary according to each individual. Therefore, it is important for the participating student to clarify the particular accommodations she or he requests
My specific disability or medical condition falls into the following category:(Required) *













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If you have tried any medical or educational interventions to manage the diagnosed condition, please explain them and describe their impact. If there are situations when the diagnosed condition has no impact on your learning, describe that here as well.
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Please explain any limitations such as ability to get to and from class, participation in school activities, eating, exercise, etc.
What accommodations are you requesting?(Required) *

Accessibility Accommodation

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Did you receive any type of special educational services while in high school?:(Required) *
Did you receive any type of special accommodations at a previous college?(Required) *
Are you a client of State/Federal Agency? (For example, Vocational Rehabilitation, VA, DBS, etc.)(Required) *
Please upload any supporting documentation related to each disability to which you are requesting reasonable accommodations.
Permission for Release of Information(Required) *
I give permission for the Office of Student Disability Services to disclose information with specific faculty and staff at NCCU, as well as with those professionals who are rendering services, when deemed appropriate for the purposes of supporting my academic, personal and/or social needs while enrolled at NCCU.