Academic/Physical University Accommodations Inquiry Student Name: Student ID# Home address: Phone: Email: Anticipated enrollment date: Summer 2016 Fall 2016 January 2016 Spring 2016 Fall 2016 January 2017 Spring 2017 Student status: Freshman Transfer Full-time student Part-time student Living on campus Commuting Check all that apply. Diagnosis (please elaborate): Accommodations being requested: High School attended: Application status: Accepted/attending Accepted/Undecided Applied Considering How did you hear about Drew University: Parent(s)/Guardian name(s): Do we have permission to talk to your parent(s)/guardian(s) directly about accommodations? Yes No Do we have permission to talk to appropriate Drew Faulty/Staff about your accommodations? Yes No Do you have a planned Drew visitation date? If so, when? And would you like an appointment with the disability coordinator during your visit (M-F 9:00 - 3:00)? Indicate visit date and best way to reach you to schedule an appt.