Initial Information Form

Completing the Initial Contact Form is the first step in connecting with the SSD office

This form is under renovation. Please excuse any issues you experience.

This form collects information from:

Current, committed, and prospective students for the University of Michigan Ann Arbor interested in or requesting academic accommodations for reason of Disability.
Students, Staff, Faculty, Guests, and Community Members to determine eligibility for Paratransit Services for the University of Michigan Ann Arbor Campus Transit System.

If you are not a student but are seeking information regarding academic accommodations, please contact the SSD front desk at 734-763-3000 or email us at ssdoffice@umich.edu. If you experience any difficulty in filling out this form, please contact us directly.

All information supplied is kept confidential and submitted directly to the SSD office.

Personal Information

First Name:

This should reflect your name on record with the university or your legal name.

Chosen (preferred) Name:

For Students, please complete if different from name on record with the university. You can change the name on record with the university by following the steps on the Spectrum Center webpage.

Last Name:

Gender Pronouns:

For example: they/them or he/him; she/her; ze/zir; they/he; or any pronouns

UM ID Number:

If none exists, please leave blank

UMich Email:

Please use your university issued email address. If you do not have a University of Michigan email, please put an email where you can be reached.

Non-UM Email:

This is for verification purposes, all office communication will go to UM email.

Cell Phone Number:

Date of Birth:

MM/DD/YYYY

What led you to connect with our office?

What is your affiliation with the university?

Academic Information

This section is for current, prospective, or admitted/committed students.

Temporary Conditions/Injuries

This section is for current or committed students who are impacted by a temporary condition/injury.

Temporary conditions/injuries refer to a short time period in which a person is impacted by a short term condition/injury such as a broken limb, concussion, or a surgical procedure.

Disability Accommodation Information

This section is for Students ( current, prospective, or admitted/committed) with a disability (medical, physical, mental, sensory condition), suspect they may have a disability, or are seeking accommodations.

Students with questions about accommodations or who are seeking accommodations for academics at the University of Michigan -Ann Arbor Campus should complete the information below.

This information is necessary for staff to be able to support you.

Paratransit

This section is for students, faculty, staff, and UofM Community who are unable to ride the UofM Transit System.

Transportation Services offers curb to curb Paratransit services for students, faculty and staff (clients) that are pre-qualified through the Office of Services for Students with Disabilities (SSD).

This is a year-round service that operates on weekdays only. Rides are provided within a .75 mile radius of the Ann Arbor campuses as well as The East Ann Arbor Health Centers and Domino's Farms satellite facilities.

Documentation/Closing

Other relevant information that be helpful to the SSD team

If you selected 'No' to paratransit, Temporary, AND Disability, please indicate why you are reaching out to the office.

Upload supporting document(s)

Please be sure to upload documentation and clearly label it prior to upload.

Upon Submission

All information supplied is kept confidential and submitted directly to the SSD office.

You will be contacted via email by the SSD Office.

For individuals affiliated with the university, communication will be sent directly to the University of Michigan email address.

If you have not heard from us after 3 business days, please contact our office at 734-763-3000