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Disabilities Accommodation Request Form

A student who requests reasonable accommodations related to a disability must provide information and recent documentation to the Coordinator of Student Disabilities Services concerning the specific disability or condition, and the desired accommodations as specified by a physician or an appropriate professional.

Grace College and Seminary desires to assist students with disabilities and help them realize their personal educational goals by working for reasonable accommodations in the academic environment. Please help us serve you by providing the information requested below.

Instructions: Complete and sign this form. Return the form and official documentation of your disability, by email or regular mail, to the address below.

  • Academic Information

  • Nature of Disability

  • Max. file size: 15 MB.
  • MM slash DD slash YYYY


Email Connie Burkholder or call 574-372-5100 ext. 6423.