Online Student Application

Welcome to the Disability Access Student Application for Accommodations.

This form is to be filled out by the student requesting accommodations on the basis of their disability; please contact us if you need help filling out this form - email disability@gonzaga.edu or call 509-313-4134.

Once you have submitted this form you will have the opportunity to upload your documentation. You will also receive an email receipt with a link to upload the documentation at another time if you prefer.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID *:
Hint: Enter 8 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:
Pronouns:

Contact Information

Primary Phone Number:
Hint: Enter 10-digit number only.
Gonzaga Email Address *:

Additional Information

Primary Disability *:
Other Disability or Note:
Seeking Degree:

Affiliation(s)

Distance Learner

International Student

Veteran

Working with CCP (Center for Cura Personalis)

Working with GU Health and Counseling

Working with Learning Strategies
Additional Note:

Questions

What is your Major?
Functional limitations caused by your condition. (How does your condition effect you?)
Describe your history of accommodation use.
What accommodation(s) do you feel you need due to your disability and functional limitations?
Is there any additional information you want included in your application?

Home
- Online Services Home

Page Tabs

Online Student Application

Page Options

Affiliation(s)

Questions

Navigation

Home

Need Help?

Disability Access