* indicates a required field
Accommodation Request Form
All of the information you provide below is provided on a voluntary basis. This information will be kept confidential and serves as a request for services only. If no services are being provided, this information will be kept on file for a period of five years from the last date of attendance.
How would you like us to refer to you when we are not using your name? (For example: she/her/hers, they/them/theirs, etc.)
If you are a student and do not have a student ID, please contact us at (618) 650-3726
Please use your university issued email address