SAS Accommodation Request Form

* indicates a required field

Student Information for Requesting Accommodations

This form is for students who are requesting accommodations for the first time. If you have any difficulty completing the form, please contact Disability Support Services at dss@udmercy.edu.

Detroit Mercy ID - T#

Detroit Mercy Email

First Name

Middle Name

Last Name

Date of Birth

Phone Number

Academic Status - Check all that apply:

Academic Major or Program:

My disability is:

Please describe your disability or disabilities:

Please describe the barriers you encounter in academic environments and in daily living because of your disability:

Do you currently have documentation of your disability from a licensed professional?

Please list any previous accommodations you have received and where you received them:

What accommodations are you requesting?

Include any housing, academic, or other accommodations.

What additional information would you like to share with us?

Upload supporting document(s). You may upload any documents that support your request for accommodations.