Accommodation Request

* indicates a required field

Student Information

Please enter your information
Date of BirthRequired
Please provide your permanent address

Include street, city, state, and zip code.


123 Rams Drive

Shepherdstown, WV 25443

Include Apt/Room Number if Applicable
Please use your university issued email address

Part II: Academic Information

Transfer StudentRequired
Are you an international student? Required

Part III: Student Self Report

Please select all that apply
Will you use a wheelchair/motorized scooter for campus mobility? Required

Part IV: Accommodations

Please check all that apply:
{"display_name":"Academic\/Classroom Accommodations ","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Please select all that apply:
{"display_name":"Housing \/ Meal Accommodations","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Check this box indicating you understand Required

I understand that by selecting this box, I agree to authorize the Office of Accessibility Services at Shepherd University to release this information to the appropriate Shepherd University faculty and staff members in the coordination of my accommodations at Shepherd University.

Part V: Documentation

Upload supporting document(s)

Please upload documentation from a qualified provider that supports your requested accommodations. Further documentation may be requested by Accessibility Services staff upon review of your application with documentation from qualified provider.