Testing Accommodations Form

At Saint Mary’s we seek to provide accommodations to students with disabilities to help them achieve academic success. If you are requesting accommodations, we ask you to complete this form, even if you have previously mentioned your concerns to a representative from Saint Mary’s University of Minnesota.

This form is to be completed only if you are requesting academic or housing accommodation.

Name*
First Last
Anticipated date of enrollment*
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
If you have a mental (depression, learning disability, etc.) or physical impairment (chronic health condition, mobility issue, vision/hearing, etc.) that substantially limits one or more of your major life activities, please specify the nature of your disability:*
What type of accommodation are you requesting?*
- Academic
- Housing
Please Describe:*
I understand that I will be required to complete a formal request for accommodation and provide supporting documentation.*
- Yes
I understand that my request will be reviewed to determine whether or not Saint Mary’s University can reasonably accommodate this request.*
- Yes
I understand and grant permission for the Directors of Wellness/Access Services to discuss my disability with other individuals at Saint Mary’s University of Minnesota for the purpose of addressing and meeting my need for reasonable accommodations.*
- Yes
By checking this box, I confirm that I agree with the above information/ Parent/Guardian must agree if student is under 18 years old.*
- Yes

Testing Accommodations Form

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