Public Accommodation Request

Student Information

Please enter your information

NOTE:

Due to the large volume of applications we receive, the average length of time it will take to hear back is one to two weeks or around 10-14 days after your application materials are submitted.

Please DO NOT submit multiple applications

If you have entered an application previously, please email any additional accommodation requests or documentation to oala@baylor.edu.

First Name

Preferred Name (if different from First Name)

Last Name

Baylor ID Number

Please enter your 9 digit Baylor ID Number

Baylor Email

Please use your university issued email address

Phone Number

Date of Birth

Place of Residence (City, State, Country)

Gender

Student Status

Major or Program of Study

Specific Group (if applicable)

How did you discover the Office of Access and Learning Accommodation (OALA)?

If your parent or guardian discovered OALA, how did they do so?

Accessibility Specific Information

Note: There is variability within each diagnosis category, and therefore, the type of accommodations needed can vary significantly. Student needs vary according to each individual. Therefore, it is important for the student to clarify the particular accommodations she or he requests.

My diagnosed disability falls into the following category:

Temporary Diagnosis?

Diagnosis Details

(date, duration, etc. as applies)

Requested Accommodations

Functional Limitations

Medications (if applicable)

Verification & Release Information

I give permission to the staff of the Office of Access and Learning Accommodation to contact my parents and/or legal guardian, my diagnosing healthcare professional(s), and/or prior educational institutions in their attempt to verify my eligibility and need for accommodations. I understand that my academic, medical, and/or psychological records provided in support of my requests for accommodations, and other records created or received by OALA concerning me, may need to be provided by OALA or will be accessible by other Baylor faculty or staff member involved in assisting me or Baylor in processing these requests, in implementing accommodations or in compliance with ADA Title III and/or Section 504.

Disclosure & Documentation Information

By completing this intake application, I am voluntarily disclosing a disability and requesting accommodations. I understand that disclosure of my disability at this time does not necessarily confirm my eligibility status for services or accommodations. I also understand that the verification process may take several weeks or longer, depending upon the appropriateness and currency of the documentation submitted.

Upload supporting document(s)

PDF file type strongly preferred

Public Accommodation Request

Student Information

Please DO NOT submit multiple applications

Accessibility Specific Information

Document Information