Loyola University Chicago

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Loyola University Chicago

Services for Students with Disabilities

Intake Forms

If you are new to SSWD, please review the forms below.  Students may complete the forms below in advance or during your meeting with a Disability Specialist.  We look forward to meeting you!

To download a form, click the desired format next to the form title. Return completed forms to Services for Students with Disabilities in the Sullivan Center for Student Services, Suite 117.

SSWD Intake Forms

Student Information Form

Intake Form (PDF)  |  Intake Form (doc)

Student Release Form

Authorization Form (PDF)  |  Authorization Form (doc)

Student Rights and Responsibility Form

Rights & Responsibilities Form (PDF)  |  Rights & Responsibilities Form (doc)


Services for Students with Disabilities
Sullivan Center for Student Services · 6339 N. Sheridan Rd., Chicago, IL 60660
Mailing Address: 1032 W. Sheridan Road, Chicago, IL 60660
Phone: 773.508.3700 · Fax: 773.508.3810
TTY: 773.508.2771

Notice of Non-discriminatory Policy