Public Accommodation Request

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Student Information

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Please use your university issued email address
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Date of Birth

Academic History

Are you transferring to UCCS from another college or university?(Required) *
Did you have an I.E.P., 504 Plan, or another form of academic-based support?

Disability and Current Impact

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Is this a temporary medical condition or injury?
Are you requesting accommodations due to a pregnancy-related condition?
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Please include the accommodation and reason below
Are you requesting Housing and/or Residential Accommodations(Required) *

Documentation

Documentation examples include IEP, 504, psychological testing, doctor's letter Acceptable formats include: .docx, .pdf.

Informed Consent for Information Release

I hereby authorize Disability Services at the University of Colorado Colorado Springs to discuss, either in writing or orally, my academic accommodations with appropriate administrators, instructors, professors, and third-party service providers as deemed necessary by UCCS Disability Services staff for the purpose of providing and/or coordinating accommodations and services for me.
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