Office of Accessibility Services Intake Form

* indicates a required field

Student Information

This is a multi-purpose form. This form can be used to:
A.) submit documentation to register with the Office of Accessibility Services
AND/OR
B.) request academic, field, or clinical accommodations for on-ground or online programs.

If you have not yet submitted documentation in order to register with OAS, attach your qualifying documentation at the end of this form.

Processing of requests and documentation submitted through this form requires 5 to 7 business days from date of receipt.

Please use your university issued email address

Documentation Submission

In order for new students to register with the OAS and confirm their eligibility to request accommodations, they must submit documentation from a health care provider or specialist which meets the documentation requirements specified on the OAS website.

If you do not have documentation, please send the Verification of Diagnosis to your practitioner.

If you are requesting accommodations and have not yet submitted qualifying documentation to the OAS, please attach your documentation below.

Attach documentation files here:

Accommodation Request Form

Enter in the following section the accommodation(s) you anticipate needing during the academic year. Please describe your accommodation need as it will apply to the college learning environment.

Accommodation Request TypeRequired
If Residential/Dining, please send the below form to your practitioner to complete.

Practitioner’s Verification of Diagnosis for Residential or Dining Accommodations

If you are a COF student, or a Simmons student who is only submitting documentation (i.e. not making an accommodation request at this time), write N/A
If needed, enter any additional accommodation requests or any additional information about your accommodation request(s) in the box below.

Agreement Statements

Statement 1Required
I understand the OAS Registration Timetable and the processing timeframe for accommodation requests as outlined on the OAS website.
Statement 2Required
I understand that my documentation submission through this form is securely delivered directly to OAS and is stored in a secure and confidential location
Statement 3Required
I understand that accommodations are applied on a prospective, not retroactive, basis.
Statement 4Required
I understand that any academic accommodation that I request and am found eligible for through the OAS and receive at Simmons University is expressly authorized for my own use only. I agree that I will not directly or indirectly share or make available my accommodations with other people.
Statement 5Required
Reasonable accommodations are implemented to provide equal access to the educational experience; accommodations cannot fundamentally alter a program's requirements, standards, and learning objectives.