Public Accommodation Request

* indicates a required field

Student Information

This form is for the purpose of allowing students to submit information necessary for requesting accommodations for disability at James Madison University. 

Please enter your information.

Please use your university-issued email address
{"display_name":"How did you learn about our services?","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}

Disability Information

Disability DurationRequired
Note: If your medical condition is not permanent in nature, the university is not required by law to provide any accommodation, but ODS may be able to assist you on a temporary basis.

Do you have another disability to report?Required

Accommodations Requested

Based on your functional limitation related to your disability, check the accommodations you believe you will need in college in order to have equal access. Accommodation approval is based on supporting documentation of disability.
Exam accommodationsRequired

General AccommodationsRequired

Accommodations for Specific Disabilities

Blind/Visual Impairment Accommodations

Deaf/Hard of Hearing

Additional Accommodations Not Listed Above

EXAMPLE: Due to my disability, I have difficulty with seeing the board from the back of the classroom. Therefore, I am requesting preferential seating.
Do you need to request another additional accommodation?

Additional Information

Personal Devices, Equipment, Assistance
If you use personal devices, equipment, and/or assistance, these are not provided by JMU and may require arrangements in some circumstances. It may be helpful for ODS to know this information in order to be a support to you during your time here at JMU. Please indicate such requirements:

Agency Affiliations

If you are registered with Virginia Department for Aging and Rehabilitative Services, please check all appropriate boxes and complete a consent form to allow exchange of information between Disability Services and Rehabilitative Services.

Clinician who prepared documentation

Permission is granted to ODS to exchange information with the clinician listed above as necessary to answer questions about the documentations submitted to support this request and in consideration of my application for accommodations.

Upload supporting document(s)Required

Guidelines for documentation are available on the ODS website. Upload supporting documentation here in a PDF or Word Document format that can be accessed without a password. If you are unable to do so, contact ODS to ensure that we will be able to read the materials you send through alternate methods such as US Mail or Fax. If we are unable to read a given file then we will contact you to re-submit the file in a different format. Please note that this will delay the review process.

Although an IEP or 504 Plan is not sufficient by itself to establish eligibility for disability accommodations at JMU, you may include copies of any IEP or 504 Plan.  This will provide information about services in the past.  Be sure the information provided demonstrates current need as a young adult entering college.

As a student, you may choose to attach additional explanations or personal statements, as necessary, in your scanned document(s) to help us understand your perspective on your need for accommodations.

Acknowledgment and Signature

Disability Services must receive this form and appropriate documentation of your disability to support requested accommodations prior to consideration and provision or approval of accommodations. Once documentation is receive and reviewed, the applicant will need to meet with Disability Services office staff to discuss accommodations, procedures, and policies. Information regarding disability is kept in Disability Services and is considered an academic record but is no noted in any way on the student's transcript.

I, the undersigned James Madison University student, give permission to the professional staff at the Disability Services Office to discuss issues and release information relevant to my disability and my access to the services, programs and courses at JMU with appropriate University officials, faculty, and staff. I understand that this primarily relates to information necessary to determine and provide appropriate and reasonable accommodations, if such accommodations are requested, and information provided to employees with a legitimate need to know, and that I will be advised prior to other consultations or disclosures of information. I also understand that the Disability Services staff are responsible employees and mandated reporters, and are required to report any information that indicates past or present child abuse (under University Policy 1406), past or present sexual abuse or misconduct (under University Policy 1340), past or present fraud (under University Policy 1603) or potential intent of harming yourself or others, among other instances constituting an emergency (under University Policy 2112).

I understand that my consent to release this information will remain in effect for the duration of my enrollment at JMU and that I may withdraw this consent in writing. Please note that ODS will exchange information with other relevant authorities on campus to evaluate and facilitate the provision of accommodations. Permission is granted to ODS to exchange information with the clinician listed below as necessary to answer questions about the documentations submitted to support this request and in consideration of my application for accommodations.

By signing this form, you are signifying your knowledge of and agreement with these practices for consent for the review of your request for accommodations.

Please type your full name here and input today’s date below.