Application for Reasonable Accommodations
Guidelines for Requesting Reasonable Accommodations
Students requesting reasonable accommodations (academic and housing) must initiate the application process by applying through the Office of Accessibility Services.
Covered disabilities may include physical, sensory, cognitive, or mental health impairments that substantially limit one or more of a student's major life activities.
Under the American Disability Act (ADA), a reasonable accommodation is defined as a service that does not fundamentally alter the programs, course design, living space, and activities provided to other students. Additionally, the accommodation may not pose a financial or administrative burden to the College.
A reasonable accommodation request can be initiated at any time during the student’s academic enrollment at the College. The time to process an application may vary and the decision process does take time. The timeframe of the review process is determined on a case-by-case basis; however, students are encouraged to begin the process at least 4 weeks in advance of the date they are requesting to start their accommodations. The College may not be able to arrange for accommodations that are not requested in a timely manner. Housing accommodation requests are based on availability. Even if a student is approved for a housing accommodation, they may be placed on a waiting list.
To begin the application process, students are required to complete the following:
Online Reasonable Accommodation Request Form (see below)
Submit the appropriate supporting documentation (e.g. 504 Plan, IEP, Evaluation)
Meet with the Director of the Office of Accessibility Services
Once the application process is completed and approved, the student will receive accommodation letters. Students are responsible for submitting the appropriate letter to faculty and/or administrator.
All supporting documentation is confidential and will be placed on file by the Office of Accessibility Services.
I am applying for
Semester
Year
Applicant Information
Last Name
First Name
Middle Name
Mount Student ID#
My Status Will Be
Select One
Currently Enrolled/Continuing
Returning from a Leave
Incoming (new/transfer)
I plan to be a
Commuter
Resident
Class of
Date of Birth (month/day/year)
Month
Select One
January
February
March
April
May
June
July
August
September
October
November
December
Day
Select One
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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25
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29
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31
Year(yyyy)
Campus Address
Residence Hall
Room Number
Home Address
Address 1
Address 2
City
State
Zip
Email
Cell Phone
Home Phone
Indicate the nature of your disability. Check all that apply:
Mobility Impaired
Visually Impaired
Learning Disabled
Hearing Impaired
Mental Health
Attention Deficit Disorder (ADD/ADHD)
Autism Spectrum
Physical or Intersystem Medical Condition
(please specify)
Other
(please specify)
Describe how your disability substantially limits one or more major life activities and your ability to participate in college programs.
What documents will you be submitting? Check all that apply:
IEP/504
School Exit Summary
Clinical or Educational Evaluation Report
Letter of accommodations from other college attended (for transfer students)
Medical letter/Documents
(please specify)
Other
(please specify)
Check and/or list all your requested accommodations below:
(Accommodations will only be approved if they are supported by documentation).
Alternative Testing Location
Extended Test Time
Housing Requests
(complete the next section)
Other accommodation requests:
For housing accommodation requests only, answer the following questions. Otherwise, skip to the bottom of the page.
Have you previously applied for housing accommodations?
Yes, I previously applied for housing accommodations.
No, I have not previously applied for housing accommodations.
If you answered yes, what was the decision?
Approved
Denied
If approved, what housing accommodations did you receive?
(Include if you were placed on a waiting list or if you declined the offered accommodation)
What types of housing accommodations are you currently requesting and why?
(Please be specific)
Office of Accessibility Support Services Permission to Release Information
I understand that it is my responsibility to provide the college with the documentation that outlines my need for reasonable accommodations. Your signature verifies that you authorize disclosure of your accommodations to the appropriate personnel of the college in order to provide necessary services.
By signing my name below, I authorize the Director of the Office of Accessibility Services at the College of Mount Saint Vincent to disclose my accommodations, in writing and verbally, to my instructors and professors, appropriate administrators and college service providers, or to persons of the college deemed necessary by the Director to coordinate my academic support services.
Please type your name to confirm that you agree to this contract.
Full Name (filling in this box is considered the same as a signature):
Date (mm/dd/yyyy):
