Accommodation Request

* indicates a required field

Student Information

Please enter your information
Date of BirthRequired
Please list emergency contacts name, relationship to you, and phone number

Disability Information:

Do you have a diagnosis? Can you describe symtpoms or struggles?
In high school, did you have an IEP or 504 Plan?Required
Are you requesting accommodations because of a temporary disability or acute condition? Required
i.e. concussion, accident, injury, surgery, etc?
Have you ever registered as a student with a disability at another college or university? Required
Is this the first time that you are requesting any kind of accommodations at Fresno Pacific University?Required

Accommodation Information

Are you requesting academic accommodations?Required
Are you requesting housing accommodaitons?Required
Are you requesting meal plan accommodations? Required
Are you requesting an Emotional Support Animal (ESA) accommodation?Required


Upload supporting document(s)
This can be a health care provider's note/letter, diagnosis on a patient portal, proof of history of accommodations, etc. Please ask if you have questions.

Release of Information