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Initial Accommodation Request
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indicates a required field
Student Demographics
Please provide the following information about yourself:
First Name
Required
*
Last Name
Required
*
Preferred Name:
Banner ID
Required
*
(ex. B00XXXXXX)
Phone Number
Buffalo State Email Address
Required
*
(@buffalostate.edu)
My diagnosed disability falls into the following category
Click on all the disabilities that apply to you. If you do not see your disability listed and/or are unsure, please select 'Other' and enter your disability in the space provided below.
[select]
ADHD
Autism Spectrum Disorder
Blind/Low Vision
Communication/Speech Disorder
Deaf/Hard of Hearing
Learning Disability
Mental Health Disability
Physical/Medical Disability
Other - Not Listed
clear
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Other - Not listed
Accommodations I would like to request
Required
*
What year and semester are you requesting accommodations for?
Required
*
Example: Fall 2023
Are you registered to vote?
Are you registered to vote?
Yes
Are you registered to vote?
No
Upload your Documentation of Disability
Document Information
Document Title
Required
*
File
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*
Maximum file size: 10240kb
Description