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Online Student Application

Two easy steps to register
Welcome to the Disability Access Center (DAC) Request for Reasonable Accommodations form!

  • Please complete the following form. You will also need to provide formal documentation of your disability.
  • Documentation Guidelines are available on the Disability Access Center (DAC) website ( or by emailing
  • The University of Wisconsin Platteville may require further documentation to substantiate the request for accommodations.
  • All information submitted to DAC will be maintained and used in accordance with applicable confidentiality requirements.
  • Please do not submit original copies of your documentation. All records received by DAC at UW-Platteville will be destroyed seven years after the last enrollment term.
  • Communication from DAC will be prompt, using the student's UW-Platteville email address as the primary mode.
  • Both this form and supporting documentation must be received before a review by DAC will proceed.
  • If you would like to meet or converse with DAC staff prior to submitting a request, please email or call our office at 608-342-1818.
Personal Information
  1. Note: Select when you would like to start your services.
  2. Note: Please select campus location where you will be enrolled.
  3. Note: Select when you plan to graduate.
  4. Hint: Enter 9 alpha numeric characters.
  5. Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Contact Information
  1. Hint: Enter 10-digit number only.
  2. Hint: Enter 10-digit number only.
Local Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address

  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Secondary Disability(ies)


    Autism Spectrum Disorders

    Brain Injury

    General Category

    Health Impairment

    Hearing Disability

    Learning Disability

    Physical/Mobility Disability

    Psychological Disabilities

    Visual Disability

  2. Affiliation(s)
  3. Ethnicity(ies)
  4. Campus Location(s)


    Functional Limitations (Please check any of the major life activities listed below that you believe are affected as a result of your diagnosed condition)
    Do you want help to register to vote? * (Selection is Required)
    Are you receiving Wisconsin G.I. bill tuition remission funding? * (Selection is Required)
    Are you registered with Division of Vocational Rehabilitation (DVR)? * (Selection is Required)
    What student status best describes you? * (Selection is Required)
    I am or will be living in the residence halls and require one or more accommodations due to a disability. * (Selection is Required)
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