In institutions of higher education, disability resource professionals (DRPs) have the responsibility of upholding compliance with federal legislation regarding college students with disabilities. Specifically, DRPs are tasked with determining reasonable accommodations to ensure access to all aspects of the campus community while simultaneously maintaining the integrity of academic programs. Despite the complexity of this role, there is limited research and guidance on how to make accommodation decisions. Further, existing guidance provides inconsistent recommendations for practice. As a result, DRPs use multiple, largely unexplored processes to determine accommodations unique to their institutional or professional discretion. The purpose of this study, therefore, was to explore how DRPs approach accommodation decision-making for college students with disabilities. DRP participants discussed factors they considered when making accommodation decisions, processes used to determine accommodations, and exceptions to these processes. The authors conclude with directions for future research and recommendations for higher education disability resources.