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Campus-Wide Reasonable Accommodation Form

If you have a diagnosed disability or chronic health condition and wish to request housing, dining, or parking accommodations, please have a qualified provider complete the Reasonable Accommodation Form. This information will be used to determine eligibility for reasonable accommodations under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. 

The information from your provider must establish a specific disability that substantially limits one or more major life activities and must support the request for accommodations.  A diagnosis of a condition in and of itself does not automatically qualify an individual for accommodations.  Complete all sections of this form thoroughly.  Please attach additional information or documentation to this form as needed.

After this is submitted, the Accessibility Committee comprised of a representative of the Office of Student Accessibility Services (OSAS), Counseling and Student Development, Health Services, and Housing are collectively responsible for reviewing and making determinations on your request. 

Once a determination has been made, you will be notified via your UMassD email.

The Committee meets monthly to review submissions.

ADA accommodations are approved for one academic year at a time. This means a new form must be completed by your provider and submitted yearly for consideration. 

Accommodations are determined on a case-by-case.

Please submit your form via:

Location: Office of Student Accessibility Services (OSAS), Pine Dale Hall, Room 7136
Fax: 508-910-6691


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