SHU Self-Identification Form

* indicates a required field

Student Information

Please enter your information
Disability Support Services (DSS) coordinates reasonable accommodations and services for undergraduate and graduate students with documented disabilities in compliance with Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and the Americans with Disabilities Act Amendments of 2008. Please refer to the DSS website for specific documentation requirements and complete registration instructions.
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Please use your university issued email address
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Have you received accommodations in the past?(Required) *
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Emergency Preparedness

Do you require the use of an elevator?(Required) *
Can you go up/down stairs?(Required) *
Will you require assistance in an emergency evacuation?(Required) *
Referral Information
Please indicate how you learned about DSS












Are you currently affiliated with any of the following campus programs? (Required) *
Check all that apply.





Are you currently receiving services from any government rehabilitation agency?(Required) *
Ex: DVR, CBVI, DDHH, VA, etc.

Information shared with DSS will be kept as confidential as required or permitted by law. It is the student’s responsibility to voluntarily and confidentially disclose information regarding the nature and extent of their qualifying disability to the office of Disability Support Services. Completion of this form does not guarantee eligibility for disability services.

I understand that my registration with DSS is not complete until I schedule and complete an intake appointment with a DSS Administrator and submit the appropriate documentation. I also understand that I am responsible for understanding and adhering to all policies and procedures as explained on the DSS website.