Merrimack Accommodation Request Form

* indicates a required field

Student Information

Please enter your information
Email address should end in @merrimack.edu
Affiliations








Specific Accommodation Information

Are you requesting Academic Accommodations?Required
Are you requesting Academic Accommodations?
Are you requesting nonacademic accommodations?Required
(Parking, Housing, Dietary)
Attach Documentation
For example: IEP, Neuropsychological Testing, 504 Plan, Doctor's Letter, ***If nonacademic - request cannot be completed without Medical Provider Form***