Baylor University
Office of Access and Learning Accommodation
Paul L. Foster Success Center

Baylor > Office of Access and Learning Accommodation > Student Resources > How to Request Services > Application for Reasonable Accommodations


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




Access and Learning Accommodation
One Bear Place #97204
Waco, TX 76798
254.710.3605
254.710.3608 (fax)
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