Request for Accommodations Form

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Student Information

The Disability Services office expects students to submit this form if:

1. You have a documented medical, learning or psychological disability supported by a current psycho-educational evaluation or other documentation as per Occidental College documentation guidelines.

2. You have a current documented medical, learning or psychological disability, or

3. You believe you have a disability and would like more information about Occidental’s documentation requirements.

Students may request accommodations at any time during the academic year. If a request is submitted after July 1st, Occidental College cannot guarantee that it will be able to meet the accommodation needs during the semester or term in which the request is received, though every effort to meet the need will be made, depending on availability.

First Name

Last Name

Oxy Student ID Number

Please use your Oxy email address

Phone Number

Accommodation Request Details

Please briefly describe your disability or disabilities. You may use diagnostic words or other words you feel are appropriate.

How does your disability affect your academic performance and/or other aspects of your college experience?

What type of accommodation are you requesting? Please select all that apply.

Note: For all housing accommodation requests, please review the Housing Accommodation Policy.

Please list your requested accommodations. Have you used these accommodations in the past? If so, how were they helpful?

Accommodations will be provided based on a review of appropriate documentation by Disability Services.

Is there any additional information you would like to provide?

Supporting Documentation

Documentation Guidelines

Please upload a PDF file of your documentation, which should support your accommodation request. You may also fax to (323) 341-4927, or mail your documents to Dean of Students, 1600 Campus Road F-50, Los Angeles, CA 90041-3314. If it is not possible to provide documentation by July 1st, please explain above.

Request for Accommodations Form

Student Information

Accommodation Request Details

Document Information