Accommodation Request Form for the Undergraduate Year

Middlebury College (“Middlebury”) recognizes and supports the standards set forth in Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (“ADA”), as amended, which are designed to eliminate discrimination against qualified individuals with disabilities. Middlebury is committed to making reasonable accommodations for qualified students with disabilities as required by law. We would like to take this opportunity to welcome you to the Middlebury community and to ask that you inform us of any disabilities for which you seek accommodation.

Middlebury will endeavor to make reasonable accommodations as required by applicable laws. The process and services ordinarily available at Middlebury are described in more detail in Middlebury's ADA Policy, which is available from the Disability Resource Center or on the web. Qualifying disabilities can include, for example, visual impairments, hearing or mobility impairments, psychological and medical conditions, and learning disabilities which substantially limit one or more of a person's major life activities and may necessitate modifications to the facilities, programs, or services of Middlebury.

The information that you provide regarding any needs will be shared only with those individuals involved in the coordination and facilitation of services and accommodations required to make our programs accessible to you. Middlebury reserves the right to request current documentation of physical and/or mental disabilities prior to the determination and facilitation of appropriate accommodations; documentation requirements are discussed in more detail in the ADA Policy. Both the full ADA Policy and this form are available from the Disability Resource Center in a variety of accessible formats.  


The campus at Middlebury is spread out and includes some steep hills. Students with mobility impairments may benefit from acquiring a personal mobility device, such as a motorized scooter, to assist with the navigation of the campus terrain. Please note that this type of personal equipment is the responsibility of the student. 


Similarly, the College is not responsible for services of a personal nature. Students with needs in this area are encouraged to consider obtaining a personal assistant or personal care attendant if they are unable to function independently on campus. 


Students requesting an air conditioner as an accommodation are advised that such requests should be made in accordance with the guidelines established in the Thermal Comfort Policy. 


Note: Your request for accommodation MUST be supported by current and adequate documentation. The College's documentation requirements are discussed in more detail in the College's ADA Policy, which is available from the Disability Resource Center. Generally, such documentation must: (1) be prepared by an objective professional qualified in the diagnosis of such conditions; (2) include information regarding the testing procedures followed, the instruments used to assess the disability, the test results, and a written interpretation of these results as they pertain to an educational environment and/or participation in the College's programs; (3) reflect your present level of functioning in the area related to the particular accommodations being sought; (4) be appropriately recent. Please note that if you are seeking accommodation for a specific learning disability, there are additional documentation requirements described in the ADA Policy, which is available from the Disability Resource Center.


Whenever possible, this form should be filled out by the student making the accommodation request.

Files must be less than 100 MB.
Allowed file types: gif jpg jpeg png tif doc docx pdf rtf txt.