Intake Form

Student Information

Please enter your information

First Name

Name of Use

Please note the first name that you would like for us to use when working with you.

Last Name

Middle Name

Pronouns of Use

V#

*Please be sure to include the V at the beginning of the number*

VCU Email

(@vcu.edu)

Cell Phone Number

Emergency Contact Name & Phone Number

I am requesting accommodations starting in...

Please indicate the first semester you need to receive accommodations.

If you are a first-year freshman beginning Fall 2024, are you interested in a transition support program?

Disability Information

What is your diagnosed disability/disabilities?

Select all that apply

Please describe your disability/condition and how it impacts you as a student

Please describe how your disability impacts nonacademic areas of your life

Do you use any form of assistive equipment, technology, or auxillary aids on a regular basis? If so, describe:

Is there any additional information that would be helpful for us to know to provide reasonable accommodations for you?

Service/Support History

Did you have an IEP/504 Plan/accommodations in High School?

Did you receive accommodations at a previous university?

Please indicate accommodations or support services received in high school or a previous university/college:

Are you currently receiving disability-related services from, or working with, any outside agencies?

Academic Accommodations Request

Please list the academic-related accommodations that you are interested in discussing with a SAEO case manager.

Please note, request course substitutions, housing, dining, and animal-related accommodations should be included in the “Additional Accommodations Request” section.

Additional Accommodations Request

If you are interested in discussing any additional accommodations, please provide additional information below (Optional)

Course Substitutions

For additional information please visit the section of SAEO's website on Course Substitution Requests.

Housing Accommodations

For additional information please visit the section of SAEO's website on Housing Accommodation Requests.

Dining Accommodations

For additional information please visit the section of SAEO's website on Dining Accommodations

Other Accommodations

For requests that did not fit into any of the above categories.

Supporting Documentation

Upload supporting document(s)

All Documentation Guidelines and forms can be found here: https://saeo.vcu.edu/getting-started/documentation-guidelines/. You can submit documentation later by sending it directly to the SAEO office.

Submission Verification

By checking the boxes below you are agreeing to the corresponding statements.

I acknowledge that I have read the documentation guidelines supplied by Student Accessibility and Educational Opportunity

SAEO Documentation Guidelines are available here.

I understand that I need to supply sufficient documentation & complete an intake meeting before I am eligible for accommodations

I acknowledge that information contained in this form is true & accurate to the best of my knowledge