Accessibility Services Center (ASC) Accessibility Intake Form

* indicates a required field

Student Information

Please enter your information

Please only use your university-issued email address. Access will be granted when students use Moravian email addresses.

Example: Fall, 2020
{"display_name":"Referred to ASC by whom?","hidden_field_name":"ms_field_1","init_id":"ms_field_1","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Are you transferring from another college or university?
Are you a graduate student?Required

Specific Disability/Accommodation Information

{"display_name":"What is your disability or disabilities?","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}
Have you ever received accommodations in high school or another institution?
Have you ever received accommodations through the ASC?
What category of accommodations are you requesting?Required
Upload supporting document(s)

Supported file formats include PDF and DOC.

Image files are not supported and will delay the implementation of accommodations and services.