Public Accommodation Request

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Student Information

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Accommodation Description

All accommodations fall into three categories. Descriptions of each category are below. Select the category/categories that best relate to your requested accommodation(s). If you are requesting multiple accommodations, select the option that contains all the categories related to your request.  

Academic- Accommodations that impact your experience in the classroom. (Examples: note taker, testing accommodations, Assistive Technology, etc.)

Housing- Accommodations in the residence halls. (Examples: de-lofted bed, fewest number of roommates, Dining Dollar review, etc.)

Assistance Animal- An accommodation to have an Assistance Animal accompany a student. If you are requesting to have the Assistance Animal live in a residence hall, please select "Assistance Animal and Housing"

What type of accommodations are you requestingRequired







Specific Accommodation Information

Do you use a wheelchairRequired
Will you require clear face masks to read other's lips?Required

Overview

In this section we would like to recap your requests, and you can upload your supporting documentation for review.
Upload supporting document(s)

Specific supporting documentation must be provided for each individual request. (For example academic accommodations could be supported by an IEP, 504 Plan or a psychological evaluation. For Housing accommodations a Doctor's note could be provided. For Assistance Animal requests a Doctor's note specifically stating the request for an AA is needed along with other pertinent information. Please see AA section for details.)

Please not that MMC cannot distribute your documentation to a third party. Please make sure you are only submitting a copy. 

Release of Academic and Disability Related Information

I hereby grant MMC to release any of my student information to the following person(s):
Would you like to receive text message reminders? Required

Text Message Disclaimer

By providing your phone number, you agree that the text messaging capability is predicated upon my service provider delivering the text message to me in a timely manner. I agree not to hold Symplicity responsible for missed messages and any pursuant damages. I further understand that there may be charges associated with the text messages, and these charges are ENTIRELY my responsibility.

*Standard message data rates apply*
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By signing below I am granting MMC the permission to contact the appropriate individuals including faculty and staff regarding my requested accommodations