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Welcome to Concordia University's Accessibility Support Service registration process! Please complete the request to begin the process.
To process the application, you must use your school email address (@cuw.edu.). If you have any questions regarding the request process or experience difficulties, please contact the Academic Resource Center at 262-243-4299 for Mequon, Wisconsin or 734-995-7582 for Ann Arbor, Michigan.
Personal Information
Start Term
*
:
Select One
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Winterim
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Winterim
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Winterim
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Winterim
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Winterim
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Winterim
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Winterim
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Winterim
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Winterim
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Winterim
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Winterim
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Winterim
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Winterim
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Winterim
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Winterim
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Winterim
2040 - Spring
2040 - Summer
Note: Select when you would like to start your services.
Primary Campus
*
:
Select One
Ann Arbor
Mequon (including All Center Based and Online Students)
Note: Please select campus location where you will be enrolled.
Expected Graduation Term:
Select One
2010 - Fall
2011 - Winterim
2011 - Spring
2011 - Summer
2011 - Fall
2012 - Winterim
2012 - Spring
2012 - Summer
2012 - Fall
2013 - Winterim
2013 - Spring
2013 - Summer
2013 - Fall
2014 - Winterim
2014 - Spring
2014 - Summer
2014 - Fall
2015 - Winterim
2015 - Spring
2015 - Summer
2015 - Fall
2016 - Winterim
2016 - Spring
2016 - Summer
2016 - Fall
2017 - Winterim
2017 - Spring
2017 - Summer
2017 - Fall
2018 - Winterim
2018 - Spring
2018 - Summer
2018 - Fall
2019 - Winterim
2019 - Spring
2019 - Summer
2019 - Fall
2020 - Winterim
2020 - Spring
2020 - Summer
2020 - Fall
2021 - Winterim
2021 - Spring
2021 - Summer
2021 - Fall
2022 - Winterim
2022 - Spring
2022 - Summer
2022 - Fall
2023 - Winterim
2023 - Spring
2023 - Summer
2023 - Fall
2024 - Winterim
2024 - Spring
2024 - Summer
2024 - Fall
2025 - Winterim
2025 - Spring
2025 - Summer
2025 - Fall
2026 - Winterim
2026 - Spring
2026 - Summer
2026 - Fall
2027 - Winterim
2027 - Spring
2027 - Summer
2027 - Fall
2028 - Winterim
2028 - Spring
2028 - Summer
2028 - Fall
2029 - Winterim
2029 - Spring
2029 - Summer
2029 - Fall
2030 - Winterim
2030 - Spring
2030 - Summer
2030 - Fall
2031 - Winterim
2031 - Spring
2031 - Summer
2031 - Fall
2032 - Winterim
2032 - Spring
2032 - Summer
2032 - Fall
2033 - Winterim
2033 - Spring
2033 - Summer
2033 - Fall
2034 - Winterim
2034 - Spring
2034 - Summer
2034 - Fall
2035 - Winterim
2035 - Spring
2035 - Summer
2035 - Fall
2036 - Winterim
2036 - Spring
2036 - Summer
2036 - Fall
2037 - Winterim
2037 - Spring
2037 - Summer
2037 - Fall
2038 - Winterim
2038 - Spring
2038 - Summer
2038 - Fall
2039 - Winterim
2039 - Spring
2039 - Summer
2039 - Fall
2040 - Winterim
2040 - Spring
2040 - Summer
Note: Select when you plan to graduate.
First Name
*
:
Last Name
*
:
Middle Name:
Optional: Preferred Name:
Student ID
*
:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender
*
:
Select One
Female
Male
Not Specified
Contact Information
Primary Phone Number:
Hint: Enter 10-digit number only.
Secondary Phone Number:
Hint: Enter 10-digit number only.
CUW or CUAA Email
*
:
Local Address
Address
*
:
City
*
:
State
*
:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode
*
:
Hint: Enter zipcode as 97331 or 97331-0000.
Permanent Address
Same as Local Address
Address:
City:
State:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Wyoming
International
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.
Additional Information
Ethnicity(ies)
Ethnicity(ies)
African-American
Asian or Pacific Islander
European-American
Hispanic
Multi-Racial
Native American
Other
Campus Location(s)
Campus Location(s)
Ann Arbor
Mequon (including All Center Based and Online Students)
Additional Note:
Questions
Student Type
*
(Selection is Required)
Undergraduate
Graduate/Professional
Dual-Enrolled High School
Non-Degree Seeking
Other (Specify Below)
Additional Note or Comment
Reason for Request (select all that apply)
I have tested positive for COVID-19 and am isolating in my residence
I am in quarantine due to COVID-19 exposure, symptom expression, or out-of-state travel requirements
I have a medical condition that puts me at a higher risk of serious illness from COVID-19, as defined by the CDC (Specify Below)
I have another high-risk factor, as defined by the CDC (e.g. age, obesity, pregnancy) (Specify Below)
I live with someone with a high-risk factor or medical condition, as defined by the CDC (Specify Below)
I care for someone with a high-risk factor or medical condition, as defined by the CDC (Specify Below)
I am providing care for a child whose school or childcare provider is closed or unavailable due to COVID-19 (Specify Below)
I have a medical condition or disability not included in the CDC health factors that I believe is affected by COVID-19 (Specify Below)
My current work requires me to quarantine following out of state travel so I am unable to work after my return from campus (Specify Below)
I have a financial hardship that will be created by coming to campus for my program (Specify Below)
Other (Specify Below)
Additional Note or Comment
Will any of your Fall 2020 classes have on-campus requirements?
*
(Selection is Required)
No, all of my classes will be offered fully online
Yes, at least one of my classes is in-person, hybrid, or distance enhanced (Specify Below)
I'm not sure
Additional Note or Comment
Select the option that best describes your anticipated living arrangement for the Fall 2020 semester.
*
(Selection is Required)
On-campus housing
Off-campus and within walking/commuting distance
Living outside of commuting distance (Specify Below)
Additional Note or Comment
Which adjustments are you requesting to perform your academics safely? (Select all that apply)
Academic flexibility during quarantine/isolation
Remote attendance/participation for on-campus academic requirements
Additional/enhanced personal protective equipment (PPE) (Specify Below)
On-campus housing accommodations (Specify Below)
Alternative arrangements for face covering requirement (Specify Below)
Other (Specify Below)
Additional Note or Comment
Please provide any comments or other information that may be useful in evaluating your request.
Acknowledgement
*
(Selection is Required)
I attest that the above statements are true. Falsification of this document, or of supporting documentation is grounds for referral to the Dean of Students for a Student Code of Conduct violation. I understand that my request for accommodations related to COVID-19 will alter and change the delivery of my classes and that this will be reassessed every semester.
Additional Note or Comment
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