Indiana University Southeast
Disability Services in Academic Success Center

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Request Information
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Please note: If you experience any difficulties with this online form, you may email your response to this form to the Office of Disability Services.

First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
E-mail Address:
Disability (Optional):


Would you like to receive a brochure about services from this office?
Yes        No

Documentation is required to receive accommodations at the University. Please check which form you would like to receive in order to provide proper documentation. You may also download the information through the following links.

Note: Some of these files are in PDF format. You must have Acrobat Reader to view them. Complete the PDF version via computer, download, sign and bring or mail to Disability Services.

Multiple items may be checked!

Visual Impairment Document (PDF)
Hearing Impairment Document (PDF)
Learning Disability Document (PDF)
ADD or ADHD Document (PDF)
Mental Impairment Document (PDF)
Physical Impairment Document (PDF)
Info on Accessible Parking

Additional comments or requests:

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