Accommodation Requests at UMSL
As a service to students with disabilities who are registered for classes at UMSL, Disability Access Services (DAS) can provide you with a disability notification memo for your courses. This service benefits you as a student by providing instructors information that you may need classroom accommodations or adjustments. It also verifies your eligibility to request such accommodations. Your official memo will be prepared and available on the portal for you to print and provide to your instructors.

Once this form is completed, a member of the DAS team will reach out to you to schedule an intake visit. During this time, you'll discuss your current needs and what accommodations may best serve you. Your intake visit will last roughly an hour and you're only required to meet once no matter how long you attend classes at UMSL. Of course, if you need more support, we're available as a resource. To prepare for your visit, you'll need to bring supporting documentation of your disability that has been approved by a qualified professional.

♦♦PLEASE NOTE: Disability Access Services cannot provide accommodations to a student without verifiable supporting documentation from a qualified professional (ie: IEP, psychological assessment, medical documentation, etc.).♦♦
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Student Name *
Local Mailing Address (Street/City/State/Zip Code) *
Phone Number *
UMSL Email Address *
Alternate Email Address *
Birth Date *
MM
/
DD
/
YYYY
Student ID # *
Are you a new or returning student, or are you just visiting UMSL? *
New Student
Returning Student
Visiting Student
UMSL Student Enrollment Status
When would you like your accommodations to begin? *
Of what year?
Declared Major: *
Currently enrolled in any UMSL online courses? *
Type of condition for your disability: *
Required
What specific diagnosis is your condition? *
How old were you when diagnosed with the above condition? *
What is the prognosis of your condition? *
What concerns, if any, does your condition present in the classroom environment?
How do you address those concerns?
What special equipment (if any) do you use daily?
What type of High School accommodations did you receive? *
Required
Have you had support for your condition prior to attending UMSL? *
If YES, what types of accommodations or support did you receive?
What accommodations are you requesting at UMSL? (select all that apply) *
Required
Please describe other services you think you may need:
DAS Handbook Policy
As a student registered with DAS, I understand that it is my responsibility to read and abide by the Disability Access Services Handbook. By signing this, I acknowledge that I have been informed of this responsibility and agree to its terms and conditions.
Type your full name to indicate you understand the DAS Handbook Policy. *
DAS Consent to Acknowledge & Memo Notification
By signing below, you provide the DAS office with consent to acknowledge to UMSL staff and faculty that you are registered with Disability Access Services. We'll provide only information regarding the accommodations for which you're eligible. The DAS office WILL NOT disclose the nature of your disability to anyone without written consent by you or your legal guardian. Any documentation of disability information provided to the DAS office is held confidential and cannot be shared without this consent.

Your official accommodations notification memo will be made available through our secure portal at health.umsl.edu. You will be responsible for notifying and providing your instructor(s) with a copy of your accommodations memo each semester.
Type your full name to indicate you understand DAS Consent to Acknowledge and Memo Notification Policies. *
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