Accommodation Request

Student Information

Please enter your information

First Name

Middle Name

Last Name

G Number

Please use format G00000000

Email

Please use your university issued email address

Phone Number

Example: 123-456-7890

Are you currently enrolled at GVSU?

Class Standing

Will you be receiving financial aid? (grants, loans, and/or scholarships)

Are you an international student?

Are you employed?

Disability Information

Please explain any other disabilities

Please list any prescribed medication related to your disability

Upload Supporting Document(s)

Documentation of a disability must appear on official letterhead from a licensed physician, psychiatrist, social work, or other mental health professional with their License/Certification number & State of licensure and include:

1. A specific statement of the diagnosis / diagnoses.
2. A summary of related functional limitations

Do you have documentation?

Specific Accommodation Information

What type of accommodations do you use to assist you at university or home?

Are you requesting housing accommodations?

Are you requesting accommodations for study abroad?

Scheduling Information

Please provide 5 times over 3 separate days that you are available to meet with a DSR advisor. We are available for appointments Monday through Thursday from 9:00 am to 3:30 pm and Friday from 9:00 am to 1:30 pm.

Availability 1