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Office of Disability Services
SELF-IDENTIFICATION FOR UNDERGRADUATE STUDENTS WITH DISABILITIES
The Office of Disability Services (ODS) provides academic support services for students with disabilities
and assists the Office of the Dean of Undergraduate students in reviewing allowable non-academic
accommodation requests. Students with disabilities who are requesting academic accommodations
should first be registered with ODS. If you have a disability and wish to self-identify, please complete
and return this form to the address below. This form is confidential and will be shared only with
appropriate officials in compliance with the Rehabilitation Act of 1973 and Americans with Disabilities
Act of 1990.
For details of required documentation, please visit the ODS website. If you are
requesting housing or dining accommodations, please complete the Housing/Dining Special Needs
form or contact Maria Flores-Mills, Office of the Dean of Undergraduate Students at 609-258-3054.
Office of Disability Services
327 Frist Campus Center
Princeton, NJ 08544
Attention: Eve Woodman Tominey, director
Name: ________________________________ Class: ______________Date: 

Home Address: ___________________________________________________________________
Street
__________________________________________________________________________________
City
State
Zip Code
Campus Address: _________________________________________________________________
Home/Cell Phone Number: ___________/___________ Campus Phone Number: ________
E-mail Address: ___________________________________________________________________
Disability: __________________________________________________________________________
Are you currently in therapy? Yes No
If “yes” please indicate name of treating professional:
CPS: ______________________________ Other: ___________________________________
Current medications you are taking: ___________________________________________________
Accommodations Requested: _________________________________________________________
__________________________________________________________
Is there anything we should know about your disability or condition that would aid us in meeting
your needs? _________________________________________________________________________
__________________________________________________________
327 Frist Campus Center Princeton, NJ 08544
Telephone: 609-258-8840 Fax: 609-258-1621 E-mail: [email protected]
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