Public Accommodation Request

Student Information

Please enter your information.

Chapman University is committed to providing equal access to the education experience. As required by the Americans with Disabilities Act (ADA) and Section 504, Chapman University will provide reasonable accommodations to students with a disability.

This form is to be completed by the student. Fill out the form as completely as possible prior to your scheduled intake meeting with a Disability Services Specialist. The information you share will be kept confidential.

First Name

Last Name

Middle Name

Student ID

Email

Please use your university issued email address

DOB

Student Phone Number

Alternate Contact Phone Number

Class Status

What semester/year are you requesting accommodations for?

Chapman Housing Address:

If you were referred to Accessibility, please let us know by whom.

Please select your campus

Disability Information

According to the Americans with Disability Act (ADA), a disability is defined as a “physical or mental impairment that substantially limits one or more of the major life activities of such individual.”

Is your disabilty temporary or permanent?

How does your disability affect you academically?

How does your disability affect student life in general, like taking tests and studying?

Academic Accommodations

Questions will display if you are asking for academic accommodaitons

Are you requesting Academic Accommodations?

Housing (Questions will display if you are asking for housing accommodaitons)

Are you requesting Housing Accommodations?

Upload supporting document(s)

Please upload documentation supporting your accommodation request using this form.
Important: Documentation requirements may vary depending on whether you are applying for academic accommodations or housing accommodations.
For questions related to academic accommodations, please contact Disability Services at DS@chapman.edu.
For questions related to housing accommodations, please contact Sean Cutting at scutting@chapman.edu.