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Inquiry Form

If you would like further information about the Office of Disability Services or how to connect to our office, simply submit an inquiry and someone from one of our offices will be happy to connect with you!
If you would like to register for services with the Office of Disability Services please submit the registration form.

Student Information

Please select the items which best describe your situation

I would like further information about ODS

I am a parent of a student with a disability and my son/daughter would like further information

Parent's First Name *

Parent's Last Name *

Parent's Email Address *

Parent's Phone Number *

RUID or A-Number

NetID

Student's Legal First Name *

Student's Preferred First Name (if different)

Student's Middle Name

Student's Last Name *

Primary Email Address *

Secondary Email Address

Best number to reach you *

Date of Birth

📅

Inquiry

Campus *

Please describe your exact reasons for contacting the Office of Disability Services *

Please check any conditions that you have been diagnosed with, or suspect you may have *

ADD/ADHD

Learning Disability

Blind/ Low Vision

Deaf/ Hard of Hearing

Speech/ Language Disability

Psychological/Psychiatric Disability

Neurological Condition

Medical Condition

Post-Traumatic Stress Disorder

Asperger's/Autism

Brain Injury

Allergy

Mobility Concern

Other - Please explain below

I have not been diagnosed, but I believe I may have a condition

If Other, please explain

How are the above conditions affecting your experience at Rutgers? (e.g coursework, studying, housing, transportation, etc) Please explain.

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