Disability Services

Accommodation Request Form

Documentation

Student information

First name*

Last name*

Date*

Mitchell Hamline Email

Phone

Student ID number*

Address

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Enrollment option*

Traditional, on campus

Blended learning

CLEO program

Golden Gate Flex program

Diagnosis information

Diagnosis*

Upload documentation

Maximum file size: 3MB

Accommodation information

Accommodations being requested*

Previous school accommodations*

Previous exam accommodations*

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