Reasonable Accommodation Request Form

This online request form can only be used by students who have already met with DAS staff and been approved for accommodations. It is not to be used by students making an initial request for accommodations who have not yet met with and been approved by DAS staff.

Please be sure to fully complete the form below and submit it to DAS staff for review and consideration. Required fields are marked with a red asterisk *.

Personal Information

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Student Type
Accommodation Request 1
Please provide a detailed description of the accommodation(s) you are requesting (Note: Disability and Access Services must be given a reasonable amount of time to respond to an accommodation request.)

I am hereby requesting a reasonable accommodation for my disability. I grant permission to the Disability Coordinator and individuals identified by the Coordinator as necessary participants in the decision-making process (instructors, academic advisors, Medical Department staff, etc.) to review the pertinent information I have provided and discuss the matter with me and my health professional(s). If accommodations are not clearly identified in a diagnostic report, the Disability Coordinator can seek outside, professional clarification.

In general, Institute policy calls for reasonable accommodations to be made for students with disabilities on an individualized and flexible basis. It is the responsibility of students with disabilities, however, to seek available assistance at MIT and to make their needs known.

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