Student Accommodation Request

Student Information

Completing this online intake form is the first step in the accommodations process for students at Plymouth State (Register with CAS, Submit Documentation, Meet with CAS). This form should only be completed by Plymouth State students. While other Plymouth State departments, advocates, and parents may assist students, it is the student’s responsibility to complete the form.

Please complete the online intake form to the best of your ability. It is important to complete all fields. It should take approximately 5-10 minutes to complete, but exact time to complete it depends on how much you choose to share. Once you have completed the form, you will be sent additional information about how to submit documentation.

If you have questions at any time, please contact the CAS office PSU.CAS@plymouth.edu

First Name

Last Name

Preferred Name

Pronouns

USNH ID

To find your USNH ID, please login to myPlymouth: https://my.usnh.edu/dashboard

Your USNH ID will be located in your profile, which can be accessed in "User Options" in the top right corner.

PSU ID

This is your ID number that starts with "000".

Plymouth State Email

Please use your university issued email address.

Phone Number

Are you a transfer student?

Are you a veteran?

Are you an international student?

Are you a Plymouth State student athlete?

Disability Information

My diagnosed disability falls into the following category

Please select all that apply.

Please specify condition(s)

Is your disability temporary?

How does your disability impact your classroom and/or exam experiences?

How does your disability impact your experiences outside of the classroom (housing, dining, transportation, etc.)?

Accommodation Information

What type of accommodations are you requesting?

Please select all that apply.

What specific accommodations are you requesting?

What accommodations have your had in the past? How were these helpful?

Is there anything else you would like us to know about at this point?

Documentation

Please click on “Add Item” below to upload any documentation to support the request for your accommodations. Documentation is required in order to initiate the process of receiving accommodations with CAS. For more information on documentation requirements, please visit our website.

Student Accommodation Request

Student Information

Disability Information

Accommodation Information

Document Information