Public Accommodation Request

Student Information

Please enter your information

Campus *

First Name *

Last Name *

Middle Name

Email *

Please use your university issued email address

Phone Number *

Radford Student ID *

University Owned Housing Residents-In the event of an emergency *

Previously Registered with CAS? *

I am already registered with the Center for Accessibility Services (CAS), but did not use accommodations last semester.

State the disability (includes medical condition, chronic disease, recovery from addiction, temporary or permanent issues)

Describe how the issue impacts success on the college campus

Previously Received Accommodations

Please list accommodations you previously received related to this concern.

What accommodations are you requesting

Calculating

Concentrating

Learning

Time Management

Reading

Stress Management

Taking Tests and Quizzes

Writing

Other Academic Limitations

Please indicate the level of impact on applicable major life activities due to the diagnosis(es).

Attending Class

Breathing

Caring for Oneself

Hearing

Seeing

Physical Tasks

Other Physical Limitations

Acknowledgement *

If previously registered with the Center for Accessibility Services (CAS), no documentation is necessary unless there is a new diagnosis.

Upload supporting document(s)

Documentation examples include IEP, 504, psychological testing, doctor's letter

Acceptable formats include: .docx, .pdf.

How did you hear about CAS?

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