Student Accessibility Center Registration Form

* indicates a required field

Student Information

This application is for enrolled or incoming Loyola University - Chicago students who are requesting accommodations from the Student Accessibility Center (SAC) for the first time. If you have already applied for accommodations and are seeking additional accommodations please contact your assigned Accessibility Specialist or contact our main office at sac@luc.edu.

Please Note: This application should only be completed by the student themselves.

First NameRequired *

Last NameRequired *

Preferred Name

Pronouns

Student ID/LIDRequired *

ID number starts with "0000"

EmailRequired *

Please use your Loyola University issued email address:

Example: jsmith1@luc.edu

Phone NumberRequired *

Demographic Information

Which of the following diagnostic categories best describes you?Required *

Please check all that apply

What is the specific diagnosis for which you are seeking accommodations? Please list any diagnoses.Required *

Are you a incoming student to Loyola University?Required *

An incoming student would be either a first year or transfer student that has not yet taken classes at Loyola.

Are you a incoming student to Loyola University? Yes Are you a incoming student to Loyola University? No

When will be your first semester at Loyola?Required *

Example: Fall 2026

Are you a School of Law student?Required *

Are you a School of Law student? Yes Are you a School of Law student? No

What year of the program are you in as of today's date?Required *

Example: 1L, 2L, 3L

Are you a Stritch School of Medicine Student?Required *

Are you a Stritch School of Medicine Student? Yes Are you a Stritch School of Medicine Student? No

What year of the program are you in as of today's date?Required *

Example: M1, M2, M3, M4

Are you a Student Veteran?Required *

Military Veteran Student Services (MVSS) supports military affiliated students with their integration into the Loyola community. Please visit their website for additional information about the supports they provide.

Are you a Student Veteran? Yes Are you a Student Veteran? No

Are you a current or former Arrupe College student?Required *

Are you a current or former Arrupe College student? Yes Are you a current or former Arrupe College student? No

Are you a student associated with Loyola's Achieving College Excellence (ACE) TRio Program?Required *

ACE is designed to serve first-generation students, and/or students with a documented disability. Please visit their website for additional information about the supports they provide.

Are you a student associated with Loyola's Achieving College Excellence (ACE) TRio Program? Yes Are you a student associated with Loyola's Achieving College Excellence (ACE) TRio Program? No

Accommodation History

Have you previously received accommodations in high school or at another university?Required *

Have you previously received accommodations in high school or at another university? Yes Have you previously received accommodations in high school or at another university? No

Please describe any previously used accommodation(s) during high school or at other universities.

Accommodation Request

I am requesting academic accommodations.Required *

I am requesting academic accommodations. Yes I am requesting academic accommodations. No

Please describe in your own words how your current diagnosis impacts you academically.Required *

Please describe any academic accommodations you are requesting.Required *

I am requesting housing accommodations.Required *

I am requesting housing accommodations. Yes I am requesting housing accommodations. No

Please describe any housing accommodations you are requesting.Required *

Please describe in your own words how your current diagnosis impacts your on-campus housing.Required *

I am requesting temporary assistance.Required *

I am requesting temporary assistance. Yes I am requesting temporary assistance. No

Temporary Assistance

Please describe the nature of your temporary disability in your own words.

What is the timeline of recovery as detailed in documentation from a professional provider?

What type(s) of assistance are you requesting? Please describe in your own words how your daily functioning has been impacted.

I am requesting meal plan accommodations.Required *

I am requesting meal plan accommodations. Yes I am requesting meal plan accommodations. No

Please Note:Required *

While the SAC does not directly handle accommodation requests for meal plan modification, our office is able to provide accommodations in the event that a dietary restriction presents a barrier to a student's academic experience. Please indicate any academic accommodations you are requesting via the question above named, "I am requesting academic accommodations."

If you are seeking a meal plan modification or release please complete the "Meal Plan Release" form through Residence Life. These requests are reviewed separately by LUC's registered dietitian, Heather Price.

Upload supporting document(s)

Reviewing supporting documentation, in conjunction with meeting with students, is an important element in determining reasonable and appropriate accommodations for our students. If you have questions about the SAC's documentation guidelines please click here to visit our website.

Drop files here to upload

LUC Release of InformationRequired *

I understand that personnel in the Student Accessibility Center (SAC) may need to communicate with faculty, staff, and other personnel at Loyola University Chicago in order to provide accommodations for my disability. I understand that this is for the purpose of coordinating accommodations, and SAC personnel do not share diagnostic information unless it is on a need to know basis. This authorization is for internal Loyola University Chicago purposes, and it does not include permission to release information to a third party.

This consent is valid during my entire enrollment at Loyola. I understand that I may revoke this consent at any time by submitting to the Student Accessibility Center a written revocation that is signed by me and witnessed by another person who knows me.

I agree

Third Party Release of InformationRequired *

I authorize personnel in the Student Accessibility Center (SAC) to release information about my interactions with the SAC to outside parties listed below (family, providers, etc.) Please list the specific names of the individuals you are approving release of information to (example: Sue Jones instead of "mom"). If you do not wish to release information to outside parties, please enter "N/A" or "Not Applicable" in the text box.

SAC PoliciesRequired *

I understand that my request for accommodations cannot be approved until after I have had an appointment with a member of SAC staff.

I agree