Center for Accessibility Services (CAS) Application for CAS Services

Student Information

For Radford University or Radford University Carilion students with a disability who would like to request accommodations. Please complete any information related to your disability.

Campus

First Name

Middle Name

Last Name

Preferred Name

Pronouns

Radford Email

Please use your university issued email address

Phone Number

Radford Student ID

Tell CAS About Yourself

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

Describe how the disability creates a barrier in a college setting.

List Previously Received Accommodations.

Please list accommodations you previously received related to this concern.

List the Accommodations You Would Like to Discuss with a CAS Coordinator.

Impact on Major Life Activities - ACADEMIC

Calculating

Concentrating

Learning

Time Management

Reading

Stress Management

Writing

Taking Tests and Quizzes

Other Academic Limitations

Impact on Major Life Activities - PHYSICAL

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

Breathing

Caring for Oneself

Hearing

Seeing

Physical Tasks

Attending Class

Other Physical Limitations

Documentation and Submission

Acknowledgement

If applicable, upload supporting document(s)

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

Acceptable formats include: .docx, .pdf.