Intake Application

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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.

Please use your university issued email address
Date of Birth
Faculty, Parent, adviser, etc
Are you and Incoming transfer Student?Required
Are you a University Athlete?
Are you a military veteran?

Specific Accommodation Information

Temporary

Blurb Temporary impairments typically last 6 months
Are you requesting accommodations due to a temporary impairment?Required

Title IX

Conditions covered under Title IX may include: Pregnancy, Childbirth, Miscarriage, False pregnancy, Abortion, and/or recovery from these conditions.

Housing Accommodations

Residential accommodations may be provided to CCSU resident students who qualify under the Americans with Disability Act Amendment (ADAA) and Section 504 of the Rehabilitation Act of 1973 and complete the following application process. Housing request and deposit must be paid and Submission of documentation of a substantial need from a qualified physician/clinician with the following information listed. 

Documentation should include

  • A clear description of the recommended housing accommodation.
  • An explanation of how the recommended accommodation will mitigate the condition.
  • Possible alternatives to the recommended accommodation.
  • A statement of the level of need for (or consequences of not receiving) the recommended accommodation.
Are you requesting housing accommodations?Required

Meal Plan Accommodations

Central Connecticut State University’s (CCSU) Standard Meal Plan Policy requires all students living on campus to purchase a meal plan. There are several meal plan options https://www.ccsu.edu/reslife/mealPlanOptions.html . 

CCSU and our Dining Service staff have also developed options for those looking for vegetarian or vegan meals, as well as food items free from food allergens, by providing celiac diet menus and other specialized options. Please see this page for more information https://ccsudining.sodexomyway.com/explore/nutrition.

Exceptions to the Standard Meal Plan Policy for Residential students are permitted only under certain circumstances and will be considered an accommodation. All students who are applying for this accommodation will be registered with the Office of Student Disability. Students who have special circumstances requiring an exemption from the University’s Meal Plan must complete the Meal Plan Exemption Request Form and all other required material, and follow the procedures listed below. These forms must be submitted each year, 30 days prior to the first day of classes.

Are you requesting meal plan/dining accommodations?

Documentation

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.

Do you plan on uploading documents today?

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

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.

Registration for servicesRequired

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.

Please list other resources/supports you feel that you may need a referral to on campus, or in the community.

Confidentiality StatementRequired

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.