Request for Disability Accommodations

Welcome! We are excited to welcome you to Western as a Mountaineer!

Completing this Request for Disability Accommodations is the first step in the process of registering for Disability Services:

  1. Complete this form, the Request for Disability Accommodations
  2. Provide documentation of your disability
  3. Complete an intake meeting with the Disability Services Director the first week of classes.

Please use this form to request the accommodations you may need at Western State Colorado University.

To be completed by student.

Your Contact Information
Please note: Your Western email address is the official form of communication from Western. Please include it and check it on a regular basis.
Veteran Status / State Rehabilitation Status Information
Information about your disability & request:
Academic Information
If yes, please submit a copy.
Medication & Treatment Information
Additional information and documentation
Type your name above to serve as your electronic signature.
Both documentation and this request form must be received before a review by Disability Services can proceed. For more information on documentation guidelines, please visit the Disability Services website at Once you have completed these steps, please contact Western Disability Services to schedule an intake interview. Please do not submit the original copy of your documentation. All records held by Disability Services are destroyed seven years after a student leaves Western State Colorado University. Please submit this form to our office via email, fax, mail, or in person: Disability Services | Western State Colorado University| Taylor 302 | 600 N Adams St. | Gunnison, CO 81230 Phone: 970.943.7056 | Fax: 970.943.3409 | Email:
Documentation of your disability will need to be submitted prior to your intake meeting to finalize accommodations. Please select if your documentation has already been provided, will be sent, or if you do not have documentation.