UMES Accommodation Request: If you have questions about student accommodations or this form, please contact the Office of Student Accessibility Services at ADA@umes.edu or (410) 651-6135.

If you have any questions about completing this form please contact the Office of Student Accessibility Services at 410-651-6135 or via email at ada@umes.edu

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Student Information

Please enter your information

First Name

Last Name

Middle Name

Preferred Name

Preferred Pronouns

Student ID

Please use your university issued UMES address

Cell Phone Number

Campus Phone Number

What is your enrollment status at UMES?

Specific Accommodation Information

My diagnosed disability falls into the following category

How and when was your disability diagnosed and documented?

(ie: IEP or 504 Plan)

Is this your first time requesting accommodations?

What type of accommodations have you used in the past and are you requesting the same accommodations here?

Please specify the accommodations you are anticipating or requesting

Please list the people who have permission to speak to Student Accessibility Services regarding my disability and accommodations.

Please include name, relationship, and phone number for each person

Upload supporting document(s)

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Confidentiality Statement

All information disclosed on this form will be kept confidential according to federal guidelines and will be shared with appropriate college personnel on a need to know basis only.

UMES Accommodation Request: If you have questions about student accommodations or this form, please contact the Office of Student Accessibility Services at ADA@umes.edu or (410) 651-6135.

Student Information

Specific Accommodation Information

Document Information