Accommodation Request Form
Please fill out the request form to request disability accommodations and assistance from the Office of Student Services. Please note that an incomplete application may result in the denial of your accommodation request. Completed applications are sent directly to the Associate Dean of Student Services.

Application Requirements

1. Supporting documentation must be issued by a qualified, licensed professional (i.e., physician, diagnostician).
2. Documentation must be on letterhead, signed, and dated by a qualified, licensed professional.
3. Students must submit the application and supporting documentation before they can receive any accommodations.
4. Documentation, written or typed, in a language other than English must be translated and notarized.
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Email *
First and Last Name *
Student ID Number *
Email Address *
Program *
Please name and describe your disability in terms of the limitations it might place on your ability to participate in a MIIS program. *
Course Names *
Course Professors *
Testing Accommodations:
Classroom and Assignment Accommodations:
Communication Accommodations:
Please email your supporting documents for your request directly to Ashley Arrocha, Associate Dean of Student Services at aarrocha@middlebury.edu. These documents include, but are not limited to, diagnosis from a licensed medical professional, supporting documentation issued from your home or previous institution of higher learning, or documentation provided by a licensed mental health professional.
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