Initial Request for Disability Accommodations

* indicates a required field
Please use this form if you are requesting accommodations/services for the first time. Please complete all information. Documentation of your disability must also be submitted to complete your request for services. Please see the documentation guidelines for the specific required documentation.

Personal Information

include Jr., Senior, etc.
Date of BirthRequired
GenderRequired




{"display_name":"Ethnicity","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
(EMPLID)
If you do not have a cell phone number, please input "n/a".
Ok to phone?Required
OK to message?
If you do not have a cell phone number, please input "n/a".
Ok to phone?
Ok to leave a message?
Please use your university issued email address
Preferred method of contactRequired


Emergency Contact

(###) ###-####

Other Information

Check yes for those groups that apply to you and answer the corresponding follow-up questions.
VeteranRequired
International StudentRequired
Transfer StudentRequired
First Generation StudentRequired
Referred By:Required








Academic Information

Academic StatusRequired


ClassificationRequired











Input number of credit hours
Undergraduate GPA, Graduate GPA, or Law GPA

Disability Information

Please note that if you have a condition that has not been present for more than 6 months or is not expected to affect you for more than 6 months, this is not covered under disability legislation. Disability Services will work with these individuals to accommodate their needs, though.
Do you receive services from the following agencies?



Accommodation History

Did you receive accommodations on a state mandated or higher education entrance exam (i.e., SAT, ACT, GRE, GMAT, and LSAT)?Required

Accommodation Requests

Please note that your documentation of disability must support these requests.

By my signature below:
I am requesting reasonable accommodations for my disability (disorder, Illness, or condition). I understand that in order to receive reasonable accommodations, I must submit current documentation of my disability, disorder, illness or condition (guidelines are provided) to Disability Services, be found eligible for accommodations/services, and MUST request reasonable accommodations in a timely manner. I understand that I must submit request for accommodations for each semester. I certify that to the best of my knowledge, the information that I have provided is complete and accurate.

I also certify that I understand that accommodations determinations by UNT Dallas do not guarantee that any particular accommodations will be granted by anyone outside of the University including but not limited to other learning institutions or testing entities such as a State Bar or licensing agency.

Please type your name in this field
Click here to access forms to share with your providers for documentation of disability.