The Catholic University of America

Request Disability Support Information

Please fill out the form below to request Disability Support Services.

Name:
Address:
City:
 State:
 Zip:
Phone Number:
Email Address:
Are You A...
Prospective student
Admitted Student
Admitted and Deposited Student 		Parent

(If parent, are you requesting for your son or daughter? If yes, then complete the student info section)

 Special Education Teacher
College Counselor
Other
If Student, Entrance Date:
Summer Fall Spring		 Entrance Year:
If Student, Any Disabilities:
Any Secondary Disabilities:
If Student, Year Upon Entrance: Freshman Transfer Graduate Law
Information Requesting: General Information
Documentation Guidelines
Intake Packet (for admitted and deposited students only)
Other
Do you need the information in an alternative format because of a disability? Yes
No
If yes: Large Print
Braille
Electronic
Any additional notes or comments?