Skip to content
Skip to main menu
Skip to secondary menu
Public Accommodation Request
The SVA student should complete and submit this request. If you need assistance completing this form, please email disabilityresources@sva.edu from your SVA issued e-mail address.
*
indicates a required field
Student Information
Please enter your information
First Name
Required
*
Last Name
Required
*
Middle Name
Preferred Name
Required
*
Pronouns (she/her; he/his; they/their; etc.)
Required
*
Please let us know what pronouns we should use to refer to you.
Student ID
Required
*
Email
Required
*
Please use your SVA issued email address
Phone Number
Required
*
Accessibility Specific Information
What is/are your specific disability/disabilities?
Required
*
When was your disability first diagnosed?
Required
*
Are you currently taking any medications related to your disability?
Required
*
Are you currently taking any medications related to your disability?
Yes
Are you currently taking any medications related to your disability?
No
What medications are you taking? Please indicate what side effects, if any, you experience from these medications.
How does your disability affect you academically?
Required
*
How does your disability affect student life in general?
Required
*
What accommodation(s) are you requesting?
Required
*
Please type out each accommodation you are requesting.
Is there anything else we should know? Tell us here.
Who referred you to Disability Resources ?
Would you like your approved accommodations to renew automatically each semester for every class?
If you have questions or want to change your decision, please email us at disabilityresources@sva.edu.
Would you like your approved accommodations to renew automatically each semester for every class?
Yes
Would you like your approved accommodations to renew automatically each semester for every class?
No
Would you like to schedule ongoing (weekly or bi-weekly) appointments with Disability Resources staff?
Required
*
Would you like to schedule ongoing (weekly or bi-weekly) appointments with Disability Resources staff?
Yes
Would you like to schedule ongoing (weekly or bi-weekly) appointments with Disability Resources staff?
No
What is the first semester for which you are requesting accommodations?
Required
*
Summer
Fall
Year
Required
*
2025
Do you have any documentation of your disability?
Required
*
Do you have any documentation of your disability?
Yes
Do you have any documentation of your disability?
No
Upload supporting document(s)
Please upload your documentation here. If you have difficulties, you can also e-mail it to us at disabilityservices@sva.edu or bring it with you to your initial intake appointment.
Document Information
Document Title
File
Required
*
Maximum file size: 10240kb
Description