Student Request for Alternative Parking and/or Transportation Services Form

Enable additional features by logging in.

Your Information

The student requesting the alternative parking and/or transportation services must provide the following information:

Student's Full Name

Lehigh ID Number:

Cell Phone Number

Email Address

Local Address

Questions to document the reason for accommodation request

Documentation may be submitted confidentially by any of the following methods:

Submit via secure upload at the bottom of this page.
Submit via email to indss@lehigh.edu.
Submit via Fax to 610-758-1252.
Submit in person: Williams Hall, Suite 301.
Submit via mail to: Disability Support Services, Williams Hall Suite 301, 31 Williams Drive, Bethlehem, PA 18015-3126.

Briefly describe your functional limitations (i.e., how your condition impacts your need for alternate parking and/or transportation arrangements):(Required) This field is required.

What, if any, educational program, activity, or benefit are you having difficulty accessing?(Required) This field is required.

What limitation is interfering with your ability to participate in any educational program or activity or to access an educational benefit?(Required) This field is required.

What is the expected duration of your condition (i.e., how long do you believe that you will need the requested accommodation)?(Required) This field is required.

Have you had any accommodations in the past for this same limitation?(Required) This field is required.

If yes, what were they and how effective were they? This field is required.

If you are requesting a specific alternative arrangement, how will it assist you? This field is required.

Do you currently park on campus? This field is required.

If yes, please describe where you currently park. This field is required.

Where are you requesting to park? Information on campus parking zones is available at: Campus Parking Zone Map, or Campus Parking Zone Map - Text Version This field is required.

Are you requesting a temporary or permanent parking change? This field is required.

If temporary, please indicate the anticipated start and end dates. This field is required.

Do you have a state-issued disability parking permit? This field is required.

Do you require assistance traveling from your vehicle to your residence hall, classrooms, dining halls, or other places on campus? This field is required.

If yes, please explain. This field is required.

Do you require assistance traveling between different places on campus? This field is required.

If yes, please explain. This field is required.

Can you wait for a bus at a bus stop, parking garage, etc.? This field is required.

If no, please explain. This field is required.

Can you ride a bus? This field is required.

If no, please explain. This field is required.

Are you able to walk? This field is required.

If yes, what is the maximum distance you can reasonably be expected to walk? This field is required.

Do you use a wheelchair or scooter? This field is required.

Can you climb stairs? This field is required.

If no, please explain. This field is required.

By selecting "Yes", I certify that the information provided in this form is true, complete, and accurate. I acknowledge that I am requesting a reasonable accommodation. I agree to cooperate fully with the Office of Disability Support Services in responding to my request, including providing the appropriate medical documentation from my health care provider(s). I agree that I will provide the requested medical documentation in a timely manner. I understand that while the University may not grant the specific accommodation that I have requested, it will engage in good faith efforts to make a determination. I also understand that, in some cases, discussion(s) with my physician may be necessary to address my request for accommodation. In addition, if deemed necessary, the University may request an independent medical evaluation of the case.

Do you certify that the information you have provided in this form is true, complete, and accurate?(Required) This field is required.

Supporting Documentation

Documentation may be submitted confidentially by any of the following methods:

Submit via secure upload at the bottom of this page.
Submit via email to indss@lehigh.edu.
Submit via Fax to 610-758-1252.
Submit in person: Williams Hall, Suite 301.
Submit via mail to: Disability Support Services, Williams Hall Suite 301, 31 Williams Drive, Bethlehem, PA 18015-3126.

Your Information

Questions to document the reason for accommodation request

Supporting Documentation

Submission