Student Registration Form

* indicates a required field

Student Information

Please enter your information
This is an all-numeric ID number (please do not provide your NetID here).
Please use your Emory email address, or you will experience a delay in responses.
Please list your campus, school, and program (ie. Atlanta campus, Goizueta, BBA program)

Specific Accommodation Information

Temporary ConditionRequired
Is your disability temporary (less than 6 months total expected duration, including flare ups and remission)?
Injury a head injury or concussion?
Mobility Needs
Do you have mobility limits that require Parking or Transportation (Para Transit available in Atlanta Campus only) accommodation?
Please describe the overall impact of your condition(s):
Have you ever received accommodations or support services before? If so, please briefly describe:
Please describe or list the accommodations you are requesting to use at Emory.
Do you take medication?
Difficulty in environment or tasks
Please select the environments or tasks in which you have difficulty (select all that apply):
Please describe the specific impact of your condition in each area you selected above.
Academic Concerns
If you have academic concerns, please select any concerns which apply to you (select all that apply):
Please describe your concerns with each area you selected above.
Do you use assistive technology (ex. Screen readers, software, magnifiers, etc.)? If YES, please describe what you use
Housing Needs
Do you have or anticipate any Housing needs on campus?

You will be asked to provide documentation of your disability. For information about what constitutes appropriate documentation please see these guidelines.

Upload supporting document(s)Required
PDF documents (such as a clear scan of your document) are best. Photos cannot be accepted. Rich Text formats (.rtf) are not supported by current Windows programs. TIP: uploading a document that says "I will send in a document later" can cause delays in the automated workflow. Upload a copy of your documentation here or contact the office for instructions on uploading a copy you may receive later.