New Student Accessibility Request

* indicates a required field

Student Information

Students should enter this information themselves. Parents, guardians, or others may assist, but it is important that students provide their own information on this form.

First Name

Name you have registered in SUNY Cortland's systems

Last Name

Name you have registered in SUNY Cortland's systems

Preferred name

If different than above, what would you like us to call you?

If other, please type your pronouns here if you wish

Cortland Email

Please use your SUNY Cortland email address. Emails from our office will only be sent to your SUNY Cortland email address.

Student Phone Number

Would you like to opt-in to receiving appointment reminders via text message?

Information Sharing

The Family Educational Rights and Privacy Act does not permit our office to release or discuss your academic record with third parties except where we are required or allowed by law, or when you provide permission. Please note below if you grant us permission to share information with your parent, guardian, or someone else not affiliated with SUNY Cortland. Students may revoke this permission at any time.

I grant permission to share information with specific individuals outside of SUNY Cortland.

Supporting documentation is not required to submit this form. However, it may allow us to better understand your disability and the barriers that a college environment might create. It can allow us to craft the most appropriate access plan possible so those barriers are eliminated or minimized. I am going to submit documentation now. Supporting documentation is not required to submit this form. However, it may allow us to better understand your disability and the barriers that a college environment might create. It can allow us to craft the most appropriate access plan possible so those barriers are eliminated or minimized. I plan on submitting documentation soon. Supporting documentation is not required to submit this form. However, it may allow us to better understand your disability and the barriers that a college environment might create. It can allow us to craft the most appropriate access plan possible so those barriers are eliminated or minimized. I do not have or cannot obtain documentation to submit. Supporting documentation is not required to submit this form. However, it may allow us to better understand your disability and the barriers that a college environment might create. It can allow us to craft the most appropriate access plan possible so those barriers are eliminated or minimized. I am not sure what documentation I should submit.

Additional Notes

New Student Accessibility Request

Student Information

Specific Accessibility Information

Information Sharing

Document Information