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Accommodation Request
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Student Information
Please enter your information
First Name
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Last Name
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Middle Name
Student ID
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Email
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Please use your university issued email address
Phone Number
Student Status
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New Student
WCOL Student
Transfer Student
Returning Student
Specific Accommodation Information
Primary Disability, Diagnosis, or Condition
Other Disabilities, Diagnoses, or Conditions
Describe how your condition affects your functionality in general, in the classroom, or in the residence halls.
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List any accommodations that you would like to request at Wilson College. Please be as specific as possible.
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Upload supporting document(s)
Assistance Notification
If you have questions or concerns filling out this form, contact Mike at michael.bloomford@wilson.edu
Document Information
Document Title
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File
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Maximum file size: 10240kb
Description