Lakewood University Disability Disclosure Form

Lakewood University’s Disability Services provides reasonable accommodations to all students with disabilities in order to help them achieve their academic goals. Lakewood University complies and adheres to Section 504 of the Rehabilitation Act of 1973, as amended. Lakewood University does not discriminate on the basis of disability in its admission, recruitment, academics, research, or employment assistance processes. Lakewood University promotes an environment of respect and support for individuals with disabilities.

Students are responsible for disclosing disability information and requesting accommodation, in accordance with University requirements. Students who need assistance, even on a temporary basis, are encouraged to utilize the services available through the Office of Disability Services. For more information please contact disabilityservices@lakewood.edu.

Anyone who is requesting accommodations due to a disability is required to fill out this form. Once a student has been identified to this office, we engage in an interactive process with that person to determine what accommodations, if any, are needed to ensure their equal access and participation in our community.

Student's Name: *

Date of Birth * +

Phone Number *

Email *

Preferred Pronouns

Other Preferred Pronouns
If you have preferred pronouns than those listed above, please indicate them here

What program have you enrolled in at the university? *

What is the nature of your disability and how may it affect your learning? *

What accommodations do you feel may be helpful? Please be as specific as possible. *

Can you provide supporting documents from a healthcare professional if needed? *

Can you provide a recent (within the last 5 years) individual education plan (IEP) or 504 plan prepared by a previous educational institution if needed? *

Thank you for completing this form. A representative from the academic department will be communicating with you soon (in the next two weeks) to seek more information or to discuss accommodation options.

Lakewood University

Please attach any supporting documents here: