SAS Accommodation Request Form

* indicates a required field

Accommodation Request Form

ALL PERSONAL INFORMATION AND QUESTIONS REGARDING YOUR DISABILITIES ARE REQUIRED TO BE ANSWERED FULLY AND IN DETAIL. YOUR APPLICATION WILL NOT BE CONSIDERED IF THESE QUESTIONS ARE NOT COMPLETED.

Completing the Accommodation Request Form is the first step in applying for Student Accessibility Services.

If you experience any difficulty in filling out this form, please contact the SAS office at 313-993-1158 or email, sas@udmercy.edu.

All information supplied is kept confidential and submitted directly to the SAS office.

A communication will be sent directly to the student's UDM email address after this Accommodation Request Form is completed. 

University ID T-Number only (This application cannot be completed without this UDM ID Number.)

University Email only (This application cannot be completed without a UDM email address.)

Birthdate
Academic Status - Check all that apply:Required

Disability Information

My disability is:Required
Must be completed in detail.

Accommodations

Include any housing, academic, or other accommodations.

Upload supporting document(s). You may upload any documents that support your request for accommodations.
I hereby request accommodations from the Student Accessibility Services Office at University of Detroit Mercy:

• I understand that in order to receive accommodations I must have a disability that substantially limits one or more major life activities. 

• I understand that reasonable and appropriate accommodations will be based on the information I provide and the documentation provided by a licensed medical or clinical professional. 

• I understand that services of a personal nature, such as a personal aide or tutor, or individually prescribed devices, such as wheelchairs, personal computers, or other technology, are my responsibility, and will not be provided by the Disability Support Services Office. 

• I understand that notifications to faculty are not automatic, and that I must contact Disability Support Services every semester to request my accommodations.