This case study describes a collaborative decision-making process for developing effective academic accommodations for a music major with a disability, whose prior accommodations suggested by the Disability Support Services (DSS) failed to address her needs. Cross-departmental collaboration between the DSS and the School of Music, as well as dynamic interactions among students with disabilities (SWDs), faculty members, peer tutors, and DSS specialists are emphasized. Multiple sources of information were collected, including in-depth/semi-structured interviews and a review of all relevant documentation such as case reports, weekly logs, email correspondence, results of psychological testing and academic portfolio contents. The themes that emerged from the data include resistance to the unknown, the language of negotiation, the decision-making process, and transformation (with three sub-themes: from fear of stigmatization to self-advocacy, from resentfulness to acceptance and commitment, and from reaction to pro-action). Key elements contributing to the collaborative process consist of effective communication among all members, the promotion of self-advocacy skills for SWDs, and faculty's recognition of SWDs' potential to succeed and while engaging flexible methods for delivering course content and assessing outcomes. A framework for delivering viable services for music majors with disabilities is outlined and discussed.