Student Disability Services

STUDENT WITH DISABILITY REQUEST FOR SERVICE

If you have a documented disability and require accommodations, please complete this form

Personal Information
Name:

 
Home Address
Campus or Mount Pleasant Address (if known)

OR

State:
MI

Disability Information (Please select all that apply)

If you have a temporary impairment (broken hand, on crutches, etc.) please call 989-774-3018 or email sds@cmich.edu with your request.

  

Anticipated Accommodations (Please select all that apply)

Classroom Accommodations


(request two (2) weeks prior to classes beginning)

Testing Accommodations


         (time and a half)


         (double time)

Other Accommodations

  


Appropriate documentation from a qualified professional must be submitted to:

Student Disability Services

Central Michigan University

120 Park Library, Mount Pleasant, Michigan, 49341

Voice: 989.774.3018 · TDD: 989.774.2568 · FAX: 989.774.1326

Email: sds@cmich.edu

Disability Information provided to Student Disability Services remains confidential.