Student Request for Services Form

* indicates a required field

Student Information

Please enter your information

First Name

Last Name

Middle Name

Student ID

If you are an incoming student and have not been issued an MCPHS ID number you may write "none"

Please use your university issued email address. If you are an incoming student and have not yet been issues an MCPHS email, you may use a personal email. Please refrain from using school emails from other schools unless you have indefinite access. For example, some high schools remove email access after graduation.

Phone Number

When did you/will you start classes at MPCHS?

Specific Accommodation Information

How does your disability impact you in university settings?

This could include the classroom, lab, or other university settings.

Please describe the accommodations you are requesting

Please provide your official diagnosis

My diagnosed disability falls into the following category

Are you an SPS Student?

SPS students are students enrolled in a self-paced course with the School of Professional Studies and are not matriculated into a program at MCPHS.

Upload supporting document(s)

Documentation should:

include a formal diagnosis
outline functional limitations (how the diagnosis impacts you)
provide recommendations from your provider regarding accommodations
be specific to the types of accommodations being requested

Examples may include IEP, 504, psychological testing, doctor's letter etc.

Please note: screenshots of a student's health portal or a medication prescription rarely provide adequate information for OSAA to determine eligibility.

If you have questions about supporting documentation please email OSAA@mcphs.edu or call 617-879-5995.

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Student Request for Services Form

Student Information

Specific Accommodation Information

Document Information