Establishing Eligibility Form

Student Information

Please enter your information

First Name

Last Name

Middle Name

LU Student ID

Lawrence Email

Phone Number

New Student or Returning Student

Major(s)

Veteran Status

High School Information

Please list the high schools you attended and including include dates of attendance

Previous College/University Information

Please list any previous college/university you attended including dates of attendance

Disability Information

Please describe the diagnosed disability or chronic health condition

Please describe how the disability or health condition impacts you in academic settings and/or residential settings

Please describe the type of academic accommodations and/or residential accommodations you are seeking

Did you receive accommodations in high school or from any other college or university?

Do you need physical accessibility assistance in the classroom, lab, etc?

Do you need housing accommodations?

Documentation

Collect the documentation described on "Establishing Eligibility: Documentation" on the Accessibility Services website at https://www.lawrence.edu/ideas/accessibility-services/establishing-eligibility

Upload supporting documentation

Please note: If you do not have documentation to upload at this time, please complete and submit this form.

Verification

I hereby verify that the information I have provided is true and accurate. I understand that the information provided to Accessibility Services at Lawrence University will be kept confidential unless disclosure is necessary to determine or to arrange accommodations, such as housing, auxiliary aids, services and/or other assistance, as per my request or unless required by law.

Verification Signature

Please type your full name

Establishing Eligibility Form

Student Information

Disability Information

Documentation

Document Information