Application for Reasonable Accommodations

Thank you for submitting your application to Baylor's Office of Access and Learning Accommodation. If you have any questions, feel free to call us at 254-710-3605.

*Indicates Required Field

*Personal Information
First Name:
Last Name:
Baylor ID#:
Phone: ( ) -
Email:
Date of Birth: ex. (08/08/2012)
Gender: Female || Male
Local Address
Address:
City:
Zip:
Home Address
Address:
City:
State:
Zip:

*Disability Related Information
Disability Category
(please check all that appy and list specific diagnosis with date of last diagnosis next to indication):
Specific Learning Disability Diagnosis: Date:
Mobility Diagnosis: Date:
Visual Diagnosis: Date:
Psychological Diagnosis: Date:
Cognitive Diagnosis: Date:
ADD/ADHD Diagnosis: Date:
Seizure Diagnosis: Date:
Hearing Impaired Diagnosis: Date:
Medical Condition Diagnosis: Date:
Physical Diagnosis: Date:
Orthopoedic Diagnosis: Date:
Temporary Diagnosis: Date:
Specific accommodations requested (accommodation request MUST be included):
Type of medications related to disability:
If you would like to upload your medical documentation at this time, please attach your file below.
Document Types

Academic Information
I am currently admitted to Baylor University
I am an Incoming Student Anticipated date of enrollment: ex. (08/08/2012)
Academic Status
Freshman
Sophomore
Junior
Senior
Academic School
Undergraduate
Graduate
Law
Non-Degree or Continuing Education
Academic Major:

Military Information
Active duty
Veteran