Public Accommodation Request

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Student Information

Please enter your information
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Please use your university issued email address
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Where do you live?(Required) *


Are you a Tufts student athlete?
Are you a protected veteran?
Are you an international student?

Academic Information

Is this your first semester at Tufts?(Required) *
Are you a transfer student?
School enrolled or interested in




Are you a full-time or part-time student?


Degree Program Level(Required) *





If you are not enrolled in a Summer program, please skip this question.
What is your anticipated year of graduation?(Required) *

As you complete this form, please be aware that as university officials, Student Accessibility Services staff are mandated reporters. This means that if a student self-discloses recent suicidal ideation and/or experiences related to sexual violence, relationship violence, and/or harassment that they are required to connect that student to support resources in our Office of Equal Opportunity. Next steps after this referral are completely in the hands of the student. For questions, please contact SAS at 617-627-4539 or Accessibility@Tufts.edu.

Disability Information

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Is your disability



When was your disability initially diagnosed? (approximate)
Have you given SAS a copy of your most recent diagnostic documentation?

Accommodation Information

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Appointment/Follow-Up Information

Confidentiality and Disclosure of Information

Please read the following:(Required) *

1. All information maintained by the Student Accessibility Services office is part of a student’s educational record and as such protected by the Federal Family Educational Rights & Privacy Act (FERPA).


2. Students wishing to waive their FERPA rights and allow information in their educational record to be shared with someone other than themselves must fill out and sign a FERPA release.


3. Documentation pertaining to a student’s diagnosis (including, but not limited to, diagnostic evaluations, IEPs/504 plans, medical records, etc.) should only be submitted to the Student Accessibility Services office.


4. The Student Accessibility Services office strongly advises students to keep a copy of their documentation.


5. Registration with SAS and/or the use of accommodations does not appear on student’s transcripts from the university.


6. Disclosure to the Student Accessibility Services office does not constitute disclosure to other offices, services, or professionals at Tufts University.


7. In order to use academic accommodations in a course, a student must disclose their relationship with the Student Accessibility Services office to the Faculty member of record for that course.


8. Information is only shared with other professionals at Tufts University to facilitate the provision of accommodations when necessary and/or if questions arise.


9. Information pertaining to a student’s diagnosis will not be shared with other professionals at Tufts University without written consent from the student.


10. Students requesting release of information must fill out and sign a consent form.


11. When a student has graduated or is no longer a student at Tufts University, the student’s file is kept for five years and then destroyed.


12. As university officials, Student Accessibility Services staff are mandated reporters. This means that if a student self-discloses recent suicidal ideation and/or experiences related to sexual violence, relationship violence, and/or harassment that they are required to connect that student to support resources in our Office of Equal Opportunity. Next steps after this referral are completely in the hands of the student. For questions, please contact SAS at 617-627-4539 or Accessibility@Tufts.edu.