Washburn University Student Accommodation Request

* indicates a required field

General Information

Term/Semester Required
Please select the semester you are requesting the accommodations be applied to.
Campus LocationRequired

Student Requesting Accommodation

Please use your university issued email address. It is your first and last name. Example: john.smith@washburn.edu

Questions

In unknown, write N/A.
Please select all areas that impact you:Required
What accommodations are you requesting?Required

Please select the accommodation you are requesting, click done, and then click request additional accommodations if you'd like to add a second accommodation. Repeat this process until you've finished. 

Accessibility Accommodation

If you are requesting a Course Waiver/Substitution, please acknowledge:
If not applicable, skip question.
If living on campus, please list your dorm name. Example: LLC, Lincoln, or the Village
Please provide additional information regarding your request. *ESA Request-please describe the animal you are requesting be your ESA animal including type of animal and color*
If you selected Emotional Support Animal as an accommodation, please indicate your willingness to disclose the following:
If you selected Meal Plan Exemption, please indicate if the request is also for religious reasons:
If you selected yes, please contact our Title IX/ADA Coordinator at 785-670-1509.
Please acknowledge if you are requesting premission to record lectures Required

Limitations and responsibilities for class recording.

I understand that recordings, in any learning format (in-classroom, remote, or online), lectures, and other materials created by instructors remain the instructor’s intellectual property and MUST NOT be shared, copied, or disseminated without the instructor’s written permission. Any recordings or lectures or classroom experiences are to be used solely for individual study and course instruction and are NOT to be shared, copied, disseminated without the written permission of everyone shown or heard in the recording. At the end of semester, completion of exam, etc., I will delete the recordings.”

Upload supporting document(s)

Please review our Helpful Documentation Guidelines for examples of types of documentation that can be submitted for review.

https://www.washburn.edu/studentaccessibility/files/helpful-documentation-guide.pdf

*Disclaimer prior to submitting request located at the bottom of the form:

I am voluntarily self-identifying as a person with a disability and I am submitting this form to begin the interactive process per the ADA/ADAAA. I understand that accommodations are not provided until approved. I understand that all of the requested accommodations may not be reasonable, and therefore may not be approved. I understand that I should discuss the accommodations with the faculty member who will provide them.