Online Student Application
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This application gathers information as part of the evidence needed to determine eligibility for accommodations due to a documented disability, which is defined as
1) being diagnosed with a condition, and
2) experiencing a functional impairment or substantial limitation in at least one major life area.
This application should be completed in its entirety by the student.
There are no right or wrong answers – just answer each question to the best of your ability and provide thorough information. If you have questions or need assistance completing this application, please contact us.
Information provided in this application is
confidential and will not be shared with other internal or external entities or departments.
All communication from our office regarding this application will be sent to your Samford email address. Please reach out if you have any questions on the status of your application.
Licensed to
Accessible Information Management LLC
Copyright © 2010-2024 by Haris Gunadi. All rights reserved.