Online Student Application

William Paterson University is committed to ensuring that all qualified with documented disabilities are provided reasonable accommodations and services to ensure full access to programs and services. Students with documented disabilities are encouraged to identify these needs to the Accessibility Resource Center as soon as possible after acceptance to the University. Submission of current, detailed documentation of the student’s disability with this completed Accommodation Request Form is required in order to process requests.

Personal Information

Start Term *:
Note: Select when you would like to start your services.
Expected Graduation Term:
Note: Select when you plan to graduate.
First Name *:
Last Name *:
Middle Name:
Optional: Preferred Name:
Student ID:
Hint: Enter 9 alpha numeric characters.
Birth Date:
Hint: Enter date in the following format Month/Day/Year (i.e. 12/31/2010).
Gender *:
Pronouns:

Contact Information

Cell Phone Number:
Hint: Enter 10-digit number only.
Land Line Phone Number:
Hint: Enter 10-digit number only.
Email Address *:

Local Address

Address *:
City *:
State *:
Zipcode *:
Hint: Enter zipcode as 97331 or 97331-0000.

Permanent Address Same as Local Address

Address:
City:
State:
Zipcode:
Hint: Enter zipcode as 97331 or 97331-0000.

Additional Information

Please select services you are SEEKING to request with our office, and provide documentation for your eligibility.

Requesting Accommodations at ARC

Questions

Please describe how your disability affects you academically. * (Required)
Please describe how your disability affects you personally. * (Required)
Are you requesting accommodations for the First Year Foundation Placment Test/Accuplacer?

If yes, when is it scheduled? (Specify Below)

Additional Note or Comment
Please indicate how you heard about the Accessibility Resource Center * (Required)
Please list your previous high school. * (Required)
Please list your previous university(s) or college(s). If you have not previously attended, then write "N/A". * (Required)
Are there any accommodations not listed that you are requesting? If yes, what are they? If no, then write, "N/A". * (Required)
What accommodations and/or services have you received previously? * (Required)

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Accessibility Resource Center

William Paterson University
300 Pompton Road (Speert Hall, Room 134)
Wayne, NJ 07470

Website: https://www.wpunj.edu/accessibilityresourcecenter/
Email Us: arc@wpunj.edu

Phone: (973) 720 - 2853
Fax: (973) 720 - 3293

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