Request for Services

* indicates a required field

Student Information

This form is for students who have been fully admitted to the University. Please do not enter your information if you are a prospective student.
Your ID will begin with 911
Please use your issued email address.
Do you receive Vocational Rehabilitation services?
Are you a veteran?
Are you a new student?
Are you a transient student?

Specific Accommodation Information

Disclaimer: A submitted Request for Services and documentation is not a guarantee of accommodations.

Authorization to Release Information

I hereby authorize Georgia College Student Disability Resource Center located at 231 West Hancock Street/Campus Box 123 in Milledgeville, GA 31061 to:

Release the following information: psychological, neuropsychological, and other evaluations and medical documentation needed for consideration of the extension of academic accommodations to:

Regents Center for Learning Disorders
University of Georgia
331 Milledge Hall 
Athens, GA 30602

Authorization to Communicate Information

For the following parties below, please indicate which are permitted to receive information regarding your disability, registration process, accommodations, and interaction with Disability Services Staff. 

Vocational Rehabilitation Case ManagerRequired
Georgia College Academic AdvisorRequired
Medical Provider(s)Required
Other IndividualsRequired
Upload supporting document(s)

Please upload documents in Word or PDF format. Documents should include a letter from your physician and/or psychiatrist, and copies of any psychological evaluations, IEP/504 plans from high school and confirmation of accommodations on the SAT/ACT.