Form logo

Disability Services - Intake Application for Students


Aloha and welcome to the University of Hawaiʻi West Oʻahu Disability Services for students.

Disability Services strives to ensure compliance with Title II of the Americans with Disability Act (ADA) and Section 504 of the Rehabilitation Act of 1973 (Section 504). These federal laws and regulations are designed to prevent discrimination of individuals based on their disability. We provide reasonable accommodations for students with disabilities by engaging in the interactive process. Disability Services wants to ensure that each student has accommodations tailored to their individual needs so they can have a positive and accessible academic experience at the University of Hawaiʻi West Oʻahu.

Once your intake form and any optional supporting documentation have been reviewed, the Coordinator of Disability Support and Success, Dr. Christina Pascua-Galdiano, will contact you to schedule a meeting to discuss your request for reasonable accommodations. All meetings will either be in-person, Zoom (video conference) or by telephone. 

Although it is NOT required to have supporting documentation to initiate the process of requesting for accommodations, you will be asked to submit any supporting documentation of your disability within 30 business days after our scheduled meeting. To submit the supporting documents, please upload them to https://www.hawaii.edu/filedrop/. Please use pascuac@hawaii.edu when specifying the recipient email and upload your document(s). 

If an online form is perferred by your provider to fill out, provide them with the following link: https://bit.ly/uhwo-doc

 

If you have any questions or need assistance with filling out the intake form, contact Disability Services by email at uhwoada@hawaii.edu or telephone at 808-689-2935.

*****Please fully complete the information requested in this form. Failure to provide full name and contact information will likely prevent your request from being successfully processed.*****

 
 

General Information

Please fill out the following with the information of the person requesting for disability services and/or accommodations.

 
 
 
Enable additional features by logging in.
This field is required.
This field is required.
Learn more
Example: 2021

Student Requesting Accommodation Services

 

 
 
Involved party 1

Disability and Accommodation Information

Reasonable Accommodations:
Any reasonable modification or adjustment that will allow a qualified student with a disability to access a program, service or activity or have the same rights and privileges as students without disabilities and to benefit from all educational programs and activities. Accommodations provide access to all services.

 
 
This field is required.
Are you enrolled in more than one institution in the UH System?
This field is required.
This field is required.
This field is required.
My diagnosed disability falls into the following category(ies):(Required)
You must make at least one selection.
This field is required.
This field is required.
This field is required.
This field is required.
Are you currently using any assistive technology(ies) and/or application(s)?(Required)
This field is required.
This field is required.
This field is required.
How did you hear about our Disability Services Office?(Required)
You must make at least one selection.
This field is required.
This field is required.
Information and educational records provided to Disability Services may be shared with others within the University of Hawaiʻi System for a legitimate educational purpose. However, those records will be kept confidential unless a waiver is signed by the student or is otherwise allowed by law.(Required)
This field is required.
I understand that I am responsible for all of the following: (A) Seeking and using the available services/resources for academic accommodations; (B) Completing this Intake Application; (C) Meeting with the Coordinator of Disability Support and Success to be considered for requested accommodation(s); (D) Providing supporting documentation as requested by the Coordinator of Disability Support and Success(Required)
This field is required.
I understand that although supporting documentation may NOT be needed to start the process in applying for reasonable accommodations, I do understand that I will need to submit supporting documentation of my disability within 30 business days after our intake meeting. I understand I may also provide documentation with this intake application.(Required)
This field is required.
This field is required.

Supporting Documentation

Please know that you do not need to provide documentation to begin the process of applying for reasonable accommodations. However, you are responsible in providing supporting documentation within 30 days after your scheduled meeting with the Coordinator of Disability Support and Success. You can either (1) scan and upload them here; OR (2) submit them via UH FileDrop at https://www.hawaii.edu/filedrop/ (recipient: pascuac@hawaii.edu) Note: if uploading documents via this form, the total size should not exceed 5GB. If they do, please use the UH FileDrop with the Subject line: Documentation. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission