Public Accommodation Request

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Student Information

Please enter your information
Are you a resident or commuter?
Did you have an IEP or 504 in High school, or is this a new diagnosis?

Specific Accommodation Information

Please include any assistive technology, or auxiliary aids that you may need while at Alvernia
Are you requesting ESA?
Are you connected to OVR
  • Consent to share information with OVR if they check yes
  • I hereby grant permission to the Office of Accessibility Services to release confidential information about my disability and programming, schedule, supports, residence life, meal plan at Alvernia to OVR in order to collaborate on supports that are available to me while enrolled at Alvernia.

Upload supporting document(s)
Attach documentation that is no more than 3 years old.
Certification and Acknowledgement

I certify that the foregoing statements are complete, accurate and true to the best of my knowledge.  I also understand the college may ask for further documentation from appropriate professionals for the purpose of establishing the existence and extent of my disability, illness, condition or disease and the relation to my need for a reasonable accommodation, if any.