Disability Accommodation Request
Student Responsibilities
Students desiring accommodations for a disabling condition are responsible for providing acceptable documentation to the Director of Counseling, Testing & Health Services. Acceptable documentation must have been produced by a licensed professional qualified to make the respective diagnosis and must usually be dated within the last three years. Any documentation submitted to the University for consideration must be provided in a timely manner prior to the period of stated need.

Student Information
Completion of this on-line form is required. You may also fill out the form at the Counseling, Testing & Health Services office which is located in the Mabee Student Success Center, 3rd floor. Providing this information will help UMHB in offering effective, reasonable accommodations in a timely manner to assist you as a student.
Start Request
 
What is your first name? *

 
Thanks, {{answer_P8DIjX2M8909}}. What is your last name? *

 
What is your UMHB ID Number?

 
What is your cell phone number? *

 
What is your date of birth? *

 
What is your sex? *


 
What is your address? *

Include city, state, and zip.
 
For which semester are you requesting accommodations? *

(Example: Fall 2018)
 
What is your major? *

 
What is your classification? *


 
What type of student are you? *


 
Where do you (or do you plan to) live? *


 
Which residence hall do you live (or plan to live)? *

 
Please briefly state the nature of your disability/condition, requested accommodations, and other helpful information. *

 
Attach official diagnostic documentation

Official documentation must be no older than 3 years. Diagnosis and documentation must be accomplished by a licensed professional qualified to make the respective diagnosis.
 
Attach additional official diagnostic documentation (if needed)

Official documentation must be no older than 3 years. Diagnosis and documentation must be accomplished by a licensed professional qualified to make the respective diagnosis.
 
Attach additional official diagnostic information (if needed)

Official documentation must be no older than 3 years. Diagnosis and documentation must be accomplished by a licensed professional qualified to make the respective diagnosis.
Thank you for completing the request
We'll review your request and contact you shortly.