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Online Disability Self-Disclosure

We're glad you decided to connect with us!

You can use this form to self-identify as a student with a disability, or to connect with our office to learn more about how we can support you. Determination of any accommodations or services is done through an interactive process with you.

If you are seeking accommodations or services, or want to explore if you have a disability:

Step 1: Complete this Disability Self-Disclosure Form. You can do this even if you are not sure about your disability or if you have questions. Provide as much detailed information as you can on this form. Incomplete information may delay the processing of your request.

Step 2: Please submit any supporting documentation you have when you complete this form, or you can send it later (you will be sent a secure link after you submit this form where you can upload files). Providing this information now will help our review.

Step 3: We will review the information you submitted and follow up with you regarding the next steps. This process can take some time. Please do not contact our office requesting status updates.

Information provided is kept confidential.

Please contact us if you need this form in an alternate format or are having trouble accessing this form.

For security, this form will time out after 30 minutes. Please complete within 30 minutes.

Questions? Contact us or learn more on our website.

* = Required item
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Select when you plan to graduate.
  7. Hint: Enter your 7 digit Cornell ID Number
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Questions
  1.  
    What is your status at Cornell? * (Selection is Required)
  2.  
    What is your college or school at Cornell? * (Selection is Required)
  3.  
    Which campus is your program affiliated with? * (Selection is Required)
  5.  
    Please identify one of the following: * (Selection is Required)
  11.  
    To best understand your needs, we encourage you to submit as much supporting information or documentation as you are able to. You can see examples of supporting information or documentation on our website. Note: We cannot request records on your behalf, nor can we access health/medical records at Cornell Health or elsewhere. * (Selection is Required)
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