Intake Form

First Name (preferred) *

Last Name *

Legal Name (if different from preferred)

Student ID#

Pronouns (optional)

he/him/his

she/her/hers

they/them/their

Student Email Address *

Phone Number

Major

When will you first need academic/classroom accommodations? (optional)

Fall 2024

Spring 2025

Summer 2025

If you have ever had academic/classroom accommodations at a previous school, what types of accommodations did you use?

Documentation

Ability to upload documentation through the Intake Form is temporarily out of order. Please email documentation to us directly at askdrc@louisville.edu.

I understand that submitting this form and documentation does not complete the accommodation process. I still need to complete an intake appointment with my assigned coordinator, then request accommodations in my courses. *

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