McMurry University | The SOAR Experience

Application for Disability Services

Please be sure to read the following before completing this application:
Application Instructions & Guidelines for Documentation of a Learning Disability
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Student ID (Social Security No.)	On Campus Extension	Classification

First Name	Middle Initial	Last Name

Age	Date of Birth	Gender
		Male Female

Local Address	City	State	Zip

Local Phone No.	May We Leave A Message?	E-mail Address	May We Send A Message?
	Yes No		Yes No

Permanent Address	City	State	Zip

Permanent Phone	May We Leave A Message?	Date of Initial Enrollment at McMurry	Major
	Yes No

List Disability(s)	Date of Onset/Initial Diagnosis

List limitations disability has on student's functioning at McMurry	Name of Texas Rehab Commission Counselor

Please personally describe the resonable accommodation(s) requested

In addition to submitting this online form by pressing the "submit" button below you will need to
print the Authorization for Exchange of Confidential Information Form and mail it to:
McMurry University Disability Services - McM Station Box 657 - Abilene, TX 79697
or bring it by the Disability Services office in the South Wing of President Residence Hall in the Student Affairs area. Thank You!

You may also print this form and mail it to the address listed above.
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