Accommodation Request Form - Academic and Housing (Non-ESA)

Accommodation Request Form - Academic and Housing (Non-ESA)

This form is for making academic and non-ESA related housing accommodation requests only. If you are requesting an Emotional Support Animal you must complete the ESA Request Form. If you are requesting an ESA and other accommodations, you must complete both forms.

If you need assistance completing this form, please contact the OAA at accommodations@eiu.edu or 217-581-6583.

Once all appropriate documentation is received, our office will conduct a review. After OAA reviews your request and documentation, we will reach out via email to your EIU account with one of the following responses:
-To ask for additional information or clarification.
-To schedule an intake meeting to further discuss your accommodation request.
-To notify you of the accommodation decision and next steps.

Additional information may be needed through an email, a quick phone call, or a scheduled intake meeting that can be conducted in person or virtually through Microsoft Teams. Not all accommodation requests will require an intake meeting. You may request a meeting at any time even if the OAA does not require an intake meeting with you in order to determine reasonable accommodations. You have the right to meet to discuss your request or to clarify or obtain additional information.

Please make sure you have reviewed the process for requesting accommodations in full and have reviewed the necessary documentation required for the type(s) of accommodation(s) you are requesting.
General Information
Name Name First Last
Date of Birth Date of Birth / MM / DD YYYY
E Number:
Preferred Pronouns:
Phone: Phone: - ### - ### ####
EIU Email (please include @eiu.edu)
Are you a new or current student?

Are you a new or current student? Incoming student new to EIU Current EIU student
Are you a transfer student?

Are you a transfer student? Yes No
Status based on credits:
Major
What is the first semester for which you are requesting accommodations? (ex: Fall 2026, Spring 2027, etc)
What type(s) of accommodations are you requesting?

What type(s) of accommodations are you requesting? Academic Housing
Disability Impacts

The purpose of the following questions is to serve as your self-report to supplement the disability documentation you submit. These questions will provide the OAA with more information about the limitations you experience and how those impact your academic performance/participation in EIU’s programs and the campus environment. This information helps us better understand your reason(s) for requesting accommodations at EIU and what barriers we may need to remove through reasonable accommodation. Please be as specific as possible in your responses.
What is the disability that you have been diagnosed with that you are seeking accommodations for?
At what age was the diagnosis received?
Please describe in detail the specific academic difficulties you are experiencing related to your diagnosed disability (i.e. difficulty with basic reading, reading comprehension, concentration, time management, viewing small print, fine motor ability to handwrite or type, etc.) that may impact your ability to complete or participate in academic tasks.
Please describe in detail the impacts you have experienced in the past either during your time at EIU or your most recent school setting. Where have you experienced limits to accessing and engaging in learning in the same way as other students?
Please describe in detail the impact on your everyday life functioning, daily activities, getting around campus, the residence halls, social interactions/events, and other experiences that may not be directly related to academic tasks. Where have you experienced limits to accessing and engaging in other environments in the same way as other students?
How long do your condition’s symptoms impact you (i.e. daily, weekly, monthly, etc.)? Does your condition change over time? Is your condition cyclical or constant in nature? Triggers?
Please specify the accommodations you are requesting:
Have you previously received accommodations?

Have you previously received accommodations? Yes No
Academic/Classroom Accommodation Request(s)
If none type "none" into the box:
Testing/Exam Accommodation Request(s)
If none type "none" into the box:
Communication/Technology Accommodation Request(s)
If none type "none" into the box:
Campus Accommodation Requests(s) (including housing)
If none type "none" into the box:
Other Accommodation Request(s)
If none type "none" into the box:
Please add any additional information that you would like to be considered as part of your request.

This is the description of your section break.
Supporting Documentation
Please upload appropriate disability documentation here (such as an IEP, 504 Plan, Provider Verification of Disability, Provider Verification of Housing Accommodation, etc.):

Documentation guidelines and OAA specific forms can be found on our website.
Will you be submitting additional documentation that has not been attached to this form?
Please read and sign
Confidentiality Notice
The Office of Accessibility and Accommodations at Eastern Illinois University is committed to ensuring that all information and communication pertaining to a student's disability is maintained as confidential as required or permitted by law. The following guidelines about the treatment of such information have been adopted by the OAA and will be shared with students. These guidelines incorporate relevant state and federal regulations. 1. No one will have immediate access to student files in the OAA except appropriate staff of the OAA. Any information regarding a disability is considered confidential and will be shared only with others within the university who have a legitimate educational interest. 2. This information is protected by the Family Educational Rights and Privacy Act (FERPA). 3. Sensitive information in OAA files will not be released except in accordance with federal and state laws. 4. A student's file may be released pursuant to a court order or subpoena. 5. If a student wishes to have information about their disability shared with others outside the university, the student must provide written authorization to the OAA to release the information. The student should also understand that there may be occasions when the OAA staff will share information with institutional personnel regarding a student's disability at their discretion if circumstances necessitate the sharing of information and the OAA staff have determined that there is an appropriate legitimate educational interest involved. 6. A student has the right to review their own OAA file with reasonable notification.
I have been informed of the policy regarding confidentiality and the release of information from my OAA file. I understand that OAA may release information from my file to be used in a confidential manner with appropriate university faculty and officials who have a legitimate educational interest while I am a student at Eastern Illinois University.
I understand that accommodations are not considered reasonable if it changes the essential elements of the curriculum or results in undue hardship, considering the nature, cost, and impact of the accommodation. I understand that specific information is required for documentation of disabilities and that accommodations will only be considered after a disability has been verified according to the Office of Accessibility and Accommodations documentation requirements. I have reviewed the appropriate policies and guidelines on the OAA website pertaining to my specific accommodation requests.
I acknowledge that I have read and understand the terms of this agreement as detailed above.
Date Date / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
NOTE: This form has been approved for use as of August 14, 2026. The institution reserves the right to update this form, as appropriate, at any time.