Public Accommodation Request

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Student Information

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Welcome to the Application for Student Disability Services!

If you have an immediate campus access need for a visit or Orientation, please contact the SDS office directly. For an Intake Meeting, complete all applicable information on form below so that we best understand your needs.

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Please use your university issued email address

Specific Accommodation Information

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Documentation that includes a diagnosis from a physician/clinician or is contained in a psycho-educational testing report is required to complete the Intake process and approve accommodations. Documentation requirements are different depending on the nature of the disability and the accommodation requested. Please see Documentation Requirements on the SDS website, and be sure to bring documentation to the Intake meeting, if not sent prior to the meeting. We also have a Disability Verification form to guide physicians/clinicians with needed information. See SDS Forms. Note: 504 Plans or IEPs are considered useful, but are not considered required documentation.

Accommodation History

Did you receive accommodations in high school?(Required) *
Did you have an IEP or 504 plan?(Required) *
Did you receive accommodations at another institution of higher education?(Required) *
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Please list the accommodation/s and/or auxiliary aids/services you have used in high school, or other college’s classrooms, or in living or working environments.

Nature of your current request(Required) *



Registration for services(Required) *

Are you registered with a Department of Rehabilitation Services or Bureau of Educational and Services for the Blind?

Please list any relevant community agencies or campus resources that you are currently utilizing.

Are you and Incoming transfer Student?(Required) *
Faculty, Parent, adviser, etc
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Please list other resources/supports you feel that you may need a referral to on campus, or in the community.

Confidentiality Statement(Required) *

Student’s SDS paper and electronic information is considered confidential pursuant to FERPA, and is kept secured.  Information about disabilities and the use of accommodations is only used to arrange accommodations with other staff and faculty on a need to know basis, and is not recorded on any CCSU school record or transcript. In accordance with FERPA, disability related documents will not be released to persons who are not school officials without written consent of the student, unless a FERPA exemption applies. Students have the right to review the contents of their files with a SDS Disability Specialist. Please complete a Request to Review my Records Form.

 

Central Connecticut State University (CCSU) complies with the letter and spirit of the Federal laws, the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act. Reasonable accommodations will be determined and approved only after an interactive Intake Meeting or shortly thereafter. Accommodations are based on student self-report and review of appropriate documentation.