Merrimack Accommodation Request Form

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Student Information

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Specific Accommodation Information

Are you requesting Academic Accommodations?Required
Are you requesting Academic Accommodations?
Are you interested in being a part of the Activate Program?Required
Activate supports our neurodivergent students (ASD, NVLD, ADHD, etc.). We provide success coaching, social events, peer mentoring, and career readiness support.
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***