Confidential Request Form

* indicates a required field

Student Information

Carlow University makes every reasonable effort to provide qualified applicants and students with disabilities with the opportunity to take full advantage of its programs, activities, services and facilities. The Disability Services Office (DSO) supports this commitment by arranging reasonable accommodations tailored to individual needs.

Students seeking accommodations are asked to provide documentation and comprehensive responses the questions below. This will help the DSO understand your current situation and identify access barriers that you may encounter during your time at Carlow University.

Students must complete the form below to initiate a request for disability-related accommodations.

Important Timelines:

Academic Accommodations: Requests should be submitted 6-8 weeks prior to the start of the semester and no later than August 1st to ensure accommodations are in place for the start of the Fall Semester.

Housing Accommodations: Requests should be submitted ASAP--no later than June 15th. We are unable to guarantee availability of requests submitted after this date.

Have questions or need assistance?

Call 412-578-6257 or email DSO@carlow.edu

First Name

Last Name

Pronouns

Student ID

Please enter only 7 digits of your ID, this should include one leading 0. i.e. 0123456

Carlow Email

Please use your university issued email address

Alternate Email

Phone Number

Physical Address

Where you live when you are not on campus

Date of Birth

Attendance Modality

Please share if you will be attending classes in-person, online or hybrid.

How did you learn about the DSO?

Self Assessment

Please list your disability diagnosis or identity.

Please share your disability diagnosis or relevant disability identity. Self-disclosing your disability is the first step in the process of requesting accommodations in the college environment.

Please share how your disability impacts you academically.

Please describe specific disability-related academic challenges that you experience.

Please provide as much detail as possible in this section as it will help us understand your situation and identify access barriers that you may encounter during your time at Carlow University.

Please describe the impact of your disability outside of the classroom.

Please share any other relevant information about how your disability impacts you, not related to academics.

Some examples may be dietary needs, access to housing or disability impact in social situations.

Previous Accommodations

Have you ever used disability accommodations and/or services in high school or another postsecondary institution?

Requested Accommodations

Please list the accommodations that you are requesting to address disability-related challenges.

Please note: Accommodations must be directly related to the functional limitations of your disability. An appropriate accommodation plan will be developed based on data collected from diagnostic reports and/or information gathered during the initial interview process. Appropriate accommodations are determined by the Disability Services Office and may or may not be reflective of past accommodations.

Upload supporting documentation

Disability related documentation should provide information on the functional impact of the disability so that effective accommodations can be identified. Criteria for the source, scope and content of documentation differs by disability type. Documentation may include assessments, reports, and/or letters from qualified evaluators, professionals, or institutions. Common sources of documentation are health care providers, psychologists, diagnosticians, and/or information from a previous school.

Additional information about documentation requirements is available on the Documentation Guidelines web page and is linked here for your convenience.