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The Accessibility Office Initial Appointment Request Form
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indicates a required field
Student Information
You must be a registered Bucks student in order register for accommodations with TAO.
First Name
Required
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Last Name
Required
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Middle Name
Student ID
Required
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Email
Required
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Please use your Bucks email account
Cell Phone Number
Required
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Preferred Contact Method
DISABILITY INFORMATION
What are your primary diagnoses?
Required
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What medications, if any, do you receive?
ACADEMIC ACCOMMODATIONS
How does your disability impact you in the academic setting/classroom?
Required
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What accommodations have you received in the past? Which ones were helpful; which were not?
What accommodations are you requesting with the Accessibility Office?
Required
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DOCUMENTATION of DISABILITY
Upload supporting document(s)
Documentation examples include: IEP, 504 plan, psychological testing, verification forms, doctor's letter. Please send in PDF format.
Document Information
Document Title
File
Required
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Maximum file size: 10240kb
Description