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Accommodation Registration Form
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Student Information
Please enter your information
First Name
Required
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Last Name
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Middle Name
Student ID
Required
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USD Email
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Please use your University of South Dakota issued email address
Personal Email
Cell Phone Number
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Home Phone Number
Status
USD Vermillion
USD Sioux Falls
Online
Undergraduate
Graduate
Non degree seeking
Program of Study
Anticipated Graduation Date
Veteran Status
Veteran Status
Yes
Veteran Status
No
Are you receiving Vocational Rehabilitiation services?
Are you receiving Vocational Rehabilitiation services?
Yes
Are you receiving Vocational Rehabilitiation services?
No
Counselor Name
Counselor Phone Number
Specific Accommodation Information
What is your disability?
How does your disability impact your ability to function in an academic setting?
Be specific as possible
Have you received accommodations in an educational setting before?
Have you received accommodations in an educational setting before?
Yes
Have you received accommodations in an educational setting before?
No
If yes, please describe
Are you requesting any accommodations for University Housing?
Are you requesting any accommodations for University Housing?
Yes
Are you requesting any accommodations for University Housing?
No
If yes, please describe housing accommodations you are requesting.
Upload supporting document(s)
Supporting medical provider or counselor documentation
Document Information
Document Title
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Maximum file size: 10240kb
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