Accommodation Request Form

Please complete the information below. Once this form is submitted, please schedule an appointment with our office to discuss options for accommodations by following one of the links below:

o Virtual Appointment:

o In-Person Appointment:

If you have any questions, please email us at
* indicates a required field

Student Information

Please enter your information
Please use your university issued email address
Date of BirthRequired
Programs I am participating inRequired

Have you declared a major?
Do you plan to, or are you currently living on campus?


Have you ever received reasonable accommodations based on disability or chronic illness in the past?


Are you a Molloy University Student Athlete?Required
Do you have a job outside school?
Are you involved in any Molloy College clubs?
Would you be interested in participating in discussion groups?

Our office holds Discussion Groups that are a place for students to bring lunch and chat. Dessert is provided. Are you interested?

Would you like to be added to the L.E.A.D. Club mailing list? (Leadership, Education, and Awareness of Disabilities)

L.E.A.D. is a Molloy College club (Leadership, Education, and Awareness of Disabilities). It is open to all Molloy students who have an interest in spreading awareness. 




Acceptable Documentation :

Examples are IEP or 504 Plan or a letter from your healthcare provider that:

- States a specific diagnosis

- Describes the current functional impact

- Is recent (within the last 3 years)

- Is comprehensive

- Includes recommendation for accommodations

- Evaluation must be completed by a properly credentialed professional who has no personal relationship with the individual being evaluated

Keep in Mind

- All documentation will be reviewed with the Access Directors on an individual case-by-case basis

- Determination of accommodations is an ongoing and interactive process

- Documentation of a specific disability does not guarantee specific accommodations

- After initial review, additional documentation may be required.