Student Disability Disclosure Form

Student Information

Please note: Documentation of your disability will be required to complete this form. Please have documents ready. Click here to view disability-specific documentation guidelines.

First Name

Last Name

Middle Name

Preferred name

Pronouns

Student ID

Include any leading zeroes (ex: 0000000)

WCU Email

Please use your university issued email address

Phone Number

Current academic standing

Anticipated graduation date

Are you the first person in your family to attend college?

Are you in the military or are you a veteran?

Are you a non-degree student?

Are you a transfer student?

Are you attending WCU for summer session(s) only?

Do you live on campus?

Disability/Diagnostic Information

Select your disability/disabilities

Choose all that apply

If other, please specify

Describe how your disability affects you both outside and inside the classroom, including exam and studying situations

Check any of the Life Activities listed below that you believe are affected as a result of your diagnosed condition(s)

Choose all that apply

{"display_name":"Check any of the Life Activities listed below that you believe are affected as a result of your diagnosed condition(s)","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}

List any other condition(s) affecting school that you would like to discuss

Have you received accommodations previously?

Accommodation Information

What accommodation(s) are you requesting?

Upload supporting document(s)

Click here to view disability-specific documentation guidelines.

Agreement

By signing below, I am certifying that I am, in fact, the student requesting accommodations through The Office of Educational Accessibility (OEA).

Student Disability Disclosure Form

Student Information

Disability/Diagnostic Information

Accommodation Information

Document Information