Online Accommodation Request Form

* indicates a required field

Participant Information

Please enter your information

First Name

Preferred First Name

Last Name

Middle Name

Online ID

Please enter the email you used when applying to Harvard Business School Online.

Email address used with Online Platform

Phone Number

Date

Please select your program:

Specific Disability/Accommodation Information

Please note the diagnosis or condition that requires accommodation(s)

Other Disability

Please explain the functional limitations that are a result of your diagnosis or condition

What accommodations are you requesting?

If unsure, list the areas you think may be difficult for you during the course.

Accessibility Accommodation

Accommodation Type

If other, please specify here

Program(s) of Study

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Program Month

Year

Please list any accommodations you received in the past.

Is there any additional information you wish to provide?

Are you going to be utilizing a screen reader?

Policy Agreement

Upload supporting document(s)

By clicking “Submit” you are acknowledging that this is a request for accommodations and not a guarantee of supports or services.

Online Accommodation Request Form

Participant Information

Specific Disability/Accommodation Information

Accessibility Accommodation

Document Information