Public Accommodation Request

The SVA student (not parent or guardian) should complete and submit this request for accessibility accommodations. If you need assistance completing this form, please email disabilityresources@sva.edu from your SVA issued e-mail address.

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Student Information

Please enter your information

First Name

Last Name

Middle Name

Preferred Name

Pronouns (she/her; he/his; they/their; etc.)

Please let us know what pronouns we should use to refer to you.

Student ID

Please use your SVA issued email address

Phone Number

Accessibility Specific Information

What is/are your specific disability/disabilities?

When was your disability first diagnosed?

Are you currently taking any medications related to your disability?

How does your disability affect you academically?

How does your disability affect student life in general?

What accommodation(s) are you requesting?

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 to schedule ongoing (weekly or bi-weekly) appointments with Disability Resources staff?

What is the first semester for which you are requesting accommodations?

Year

Do you have any documentation of your disability?

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.

Public Accommodation Request

Student Information

Accessibility Specific Information

Document Information