You will have as much time as you need to complete this form. However, if there is no activity on the form for 45 minutes, your session will end, and your information will be lost.
During this registration process, you will be asked to upload documentation of your disability.
Do you have a physical and/or mental disability that substantially limits one or more major life activities that would be encountered in a college residential living environment (e.g. self-care, sleeping, eating, performing manual tasks, walking, or the operation of major bodily functions)? If so, identify the disability(s) and the major life activity(s) that are substantially limited by your physical and/or mental disability
Identify the disability-related need for the housing accommodation(s) requested and explain how the housing accommodation(s) requested will alleviate or reduce the disability barrier(s).
Other than the housing accommodation(s) requested above, are there any other accommodations that could be provided to you in lieu of the request that would have an equal or greater impact on alleviating or reducing the disability barrier(s)?
e.g. gluten-free menu options, dairy and lactose free menu options, specialized diets for gastrointestinal needs
Identify the disability-related need for the meal plan accommodation requested and explain how the meal plan accommodation requested will alleviate or reduce the disability barrier(s).
Describe in as much detail as possible where you experience the greatest challenges or barriers impacting your ability to learn and demonstrate knowledge.
Please include any additional accommodation requests or other information that may be helpful for Disability Services staff to process your request.
Documentation can be in the form of:
IEP, 504 Plan, Doctor's Note, Psychoeducational Evaluation, Etc.
Please note: students requesting temporary accommodations or who do not have a diagnosis are not required to upload documentation with this form. However, documentation may be requested at the discretion of Disability Services in order to determine reasonable accommodations.
By signing my name below, I hereby give permission to Disability Services (CTL) to give/receive information related to my disability for the purpose of providing disability related accommodations. I have been told that in order to protect the limited confidentiality of records, my agreement to obtain or release information is necessary, and that this permission is limited to the purposes of ensuring access and accommodations. I understand that by written statement, I may withdraw my permission at any time. I also understand that I may ask to see the information that is to be sent.
FEDERAL REGULATIONS PROHIBIT DISCLOSURE OF THIS INFORMATION WITHOUT YOUR SPECIFIC WRITTEN CONSENT.