Prospective Student Accommodations Request Form

Student Status

Are you a student at WSSU?

Place a check mark inside each check box to affirm the following.

Student Confirmation

Disability Eligibility Review

Documentation Requirements

Cost Responsibilities

Documentation Responsibilities

First Name

Last Name

Email

Phone Number

Tentative WSSU Entering Year

Tentative WSSU Entering Term

Transfer Student

My diagnosed disability falls into the following category

Specific Diagnosis

Please list your disability diagnosis below

Limited life activity

Please describe how your diagnosis impacts your major life activities.