Penn State College of Medicine Disability Services Information Request 

Submission of this form prior to starting at Penn State University will result in further correspondence from the campus Disability Contact Liaison to provide additional information concerning services. Early receipt of this form will allow for a more timely response to your request for services. This form is intended ONLY for those students with disabilities who require academic adjustments and auxiliary aids. All students should consult the Penn State University Office for Disability Services website for additional information:

Pennsylvania State University encourages academically qualified students with disabilities to achieve full participation and integration in its educational programs. It is Penn State's policy not to discriminate against qualified persons with disabilities in its admissions policies and procedures or its educational programs, services, and activities. The University encourages students with disabilities to participate fully in its educational programs.  

Individuals who are seeking academic adjustments and/or auxiliary aids must self-disclose their need for academic adjustments and/or auxiliary aids to the Penn State location at which they are enrolled. To be eligible for academic adjustments and/or reasonable auxiliary aids, students must have a documented disability as defined by the Rehabilitation Act of 1973 or the Americans with Disabilities Act (ADA), 1990. The ADA defines a disability as a physical or mental impairment that substantially limits a major life activity. 

NOTE: The purpose of this form is to notify students that academic adjustments and/or auxiliary aids are available at all locations of Penn State University. Completion of this form will result in contact from the Penn State College of Medicine. Additional information regarding services and interviews with the Disability Services Coordinator to identify the need for reasonable accommodation will be provided.  

The information submitted on this form will remain confidential within the Office of Disability Services.