Step 1 of 3: About your needs

All questions are optional unless noted.

Please describe your disability and how you believe your disability condition(s) impacts your ability to fulfill academic requirements.

Please indicate the type(s) of disability you want the disability services staff to consider:

Attention-Deficit/Hyperactivity Disorder (ADHD)
Autism Spectrum Disorder
Blind or Low Vision
Brain Injury
Chronic Health Condition (such as seizures, diabetes, fibromyalgia)
Deaf or Hard of Hearing
Deaf/Blind
Dietary
Learning Disability
Mobility or Physical Disability
Psychological Disorder (such as anxiety, depression, or bipolar disorder)
Speech
Temporary disability (such as a broken leg or arm)

Supporting Documentation

Please upload supporting documentation (such as doctor assessments, diagnoses, or other reports) that describes each disability described above. More about acceptable documents

Step 2 of 3: Background information

Do you receive Supplemental Security Income (SSI) or Supplemental Security Disability Insurance (SSDI)?

Are you registered for state rehabilitative services?

Have you received disability accommodations in the past? If yes, please describe previous accommodations.

Please describe previous accommodations:

While in high school or another university, check if you had:

IEP (Individualized Education Program)
504 Plan

Are you a veteran of US military service? (Required)

Tell us about services that you use:

Braces
Crutches
Manual wheelchair
Motorized wheelchair
Other mobility aid
Prosthesis

Step 3 of 3: Agreement

I understand that in order for the Division of Disability Resources and Educational Services to verify my disability, as well as the functional manifestations of my disability for which academic adjustments, auxiliary aids and/or other accommodative services may be required, the office must obtain pertinent student evaluations, psychological reports, transcripts, and medical reports. I understand that to obtain these reports this form must be submitted and on file.

I understand that no one other than Division of Disability Resources and Educational Services personnel has immediate access to my submitted files, and that any information regarding my disability which is gained from these files shall be considered confidential and will only be shared with others within the institution on a need-to-know basis. I further understand that my reports will not be released except in accordance with federal and state laws.

Therefore, for the purposes noted above and in accordance with the conditions specified, I hereby authorize release of information from my reports to authorized personnel at the University of Illinois and Division of Disability Resources and Educational Services.