Public Accommodation Request

Next Steps

Since you checked off "Yes" you should not proceed and submit. You need to send an email to dss@ccri.edu instead. If you do submit, DSS staff will not receive your information.

First Name

Last Name

Middle Name

Preferred Name

Preferred Pronouns

Student ID

Please enter your 8-digit CCRI issued ID. This number begins with the digit 9.

Email

Please use your CCRI issued email address. (username@my.ccri.edu)

Phone Number

Which campus do you attend?

Public Accommodation Request

Student Information

Specific Accommodation Information