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Online Request Form - Disability Accommodation

Two easy steps to register
Welcome to the disability accommodation request process for non-students at UW-Madison and the Division of Extension.

Non-students (4-H members, visitors and program participants) and their families can use this form to make their initial:
  • accommodation request for participation in UW-Extension programs (e.g., 4-H, Master Gardeners, or Master Naturalists)
  • housing accommodation request for non-students living in UW-Madison's University Apartments

Personal and accommodation information is treated as confidential. Please fill in this form as completely as possible. If your request pertains to an Emotional Support Animal in Housing, certain questions may not be relevant to your request and may be disregarded. Thank you for taking the time to share information about your accommodation request.

This form automatically times out in 20 minutes. If you need more than 20 minutes to look up information or to type longer responses, we encourage you to type your responses in a separate document that you can save and then copy/paste your responses into this form. You will know that your request was submitted successfully when you get a screen that says "Application Submitted" (with a green check mark) AND you receive an automated email confirmation. If you do not receive email communication from an Access Consultant within 5 business days, please check your email spam or junk folder.

If you have additional requests AND if you (or your child) are already registered and approved for accommodations for Extension programs or for housing accommodations in University Apartments, please email the appropriate individual to add or update accommodation requests instead of completing this form.
  • Extension-related requests - disabilityaccesss@extension.wisc.edu
  • Housing-related requests - visitoraccess@mcburney.wisc.edu
Personal Information
  1. Note: Please select campus location where you will be enrolled.
  2. 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.
  3. Hint: If the participant is a minor, please provide parent/guardian email.
Permanent Address
  1. Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
  1. Primary Disabilities/Conditions *

    Autism Spectrum (AUT)

    Emotional Behavioral Disability/Psychological Disability (PSY)

    Health Condition (HEL)

    Hearing Disability - Deaf/Hard of Hearing (HEA)

    Mobility/Physical Disability (MOB)

    Other Disabilities (OTH)

    Other Health Impairment: ADD/ADHD (ADD)

    Specific Learning Disability (LEA)

    Speech and Language (SLI)

    Temporary Disability (TEM)

    Traumatic Brain Injury (BRA)

    Visual Disability - Blind/Low Vision (VIS)

  2. Campus Location(s)

Questions

  1.  
    For whom are you requesting an accommodation? * (Selection is Required)
  2.  
    Have you, or your child, used formal accommodations in the past (i.e. 504 plan, IEP, work accommodations) * (Selection is Required)
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