Submission Instructions: Please download, complete, and email this form, along with all supporting
documentation, to the appropriate contact below. Requests can be made at any time; however, in order for
accommodation requests to be reviewed and determined prior to the start of a term, completed forms and
documentation must be submitted by your program deadline listed below. Requests made after the deadlines
or during the term will be reviewed and determined as quickly as possible.
January 15 (for new and returning undergraduate students, spring term)
March 15 (housing accommodation requests due for returning undergraduate students, fall term)
May 1 (for MFA summer term and postbac students)
June 1 (for new undergraduate students*, and nonhousing accommodation requests for returning
undergraduate students, fall term)—please note: undergraduate housing assignments are for the full
academic year; therefore, requests made after the June 1 deadline may be more difficult to fulfill
December 1 (for MFA winter term students)
When a Student is Entitled to Accommodation: Under applicable disabilities laws, an otherwise qualified student
with a disability is entitled to reasonable accommodation in order to provide equal access to college programs and
facilities. A “disability” is a physical or mental impairment which substantially limits a major life activity, such as
caring for oneself, performing manual tasks, seeing, hearing, e
ating, sleeping, walking, standing, lifting, bending,
speaking, breathing, learning, reading, concentrating, thinking, communicating, and working, or other activities as
required by law. Bennington College works with each student to determine reasonable accommodations when the
student has filed a request for accommodation and submitted adequate documentation as provided below. Note: It
is not necessary to identify any disabilities for which you are not requesting accommodations.
Your Request for Accommodation and Required Documentation: Your request for accommodation must be as
specific as possible and normally must be accompanied by the Documentation of Disability form or an equivalent
report (e.g. a copy of a psychoeducational evaluation).
How the College Will Respond to Your Request: You may be asked to supplement the documentation you have
provided. Once we have received a specific request for accommodation from you, we will work interactively with
you to identify one or more appropriate accommodations, which may or may not be the specific
accommodation(s) you have requested. The College’s goal is to provide accommodations that are effective, even
though they may not be the specific accommodations requested in all cases.
Grievance Policy: A grievance policy for students, who believe they have been denied access to the College’s
programs or services because of a disability, including denial of a request for accommodation, is printed in the
Student Handbook, which is available on the
website or in the Provost and Dean’s Office.
Academic/Classroom Accommodations: Katy Evans (katyevans@bennington.edu)
Housing/Dining/Co-Curricular Accommodations: Christine Winget (christinewinget@bennington.edu)
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Bennington College | Provost and Dean’s Office | One College Drive, Bennington, Vermont 05201 | 802-440-4400
Student’s Name: ______________________________________________________________________________
Home Address: _______________________________________________________________________________
City: ______________________________________ State
: ______________ Zip: ____________________
Email: _______________________________________________________________________________________
Diagnosed disability: _________________________________________________________________________
Accommodation(s) I am requesting from the College: ____________________________________________
Required documentation is:
enclosed or being sent separately by deadlines listed on page one.
I authorize the College to arrange for reasonable accommodation(s), to share information with others as
and to obtain additional information from the individual(s) listed below, who has/have
diagnosed or treated me for my disability/disabilities.
Student’s Signature: ____________________________________________________ Date: _______________
Name of Diagnostician: _______________________________________________________________________
Address: ____________________________________________________________________________________
City: ______________________________________ State
: ______________ Zip: ____________________
Daytime Telephone: __________________________________________________________________________
Attach additional pages as necessary.
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Bennington College | Provost and Dean’s Office | One College Drive, Bennington, Vermont 05201 | 802-440-4400
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Student’s Name: ______________________________________________________________________________
The above-named student is requesting accommodations under The Americans with Disabilities Act of
1990, the Americans with Disabilities Amendments Act of 2008, a
nd Section 504 of the Rehabilitation Act of
1973. In order to support this student’s request, Bennington College requires documentation of the
disability (or disabilities) by a qualified professional. Documentation may consist of completing this form
or substituting a diagnostic report.
In the context of requests for reasonable accommodations, the term “disability” means a physical or mental
impairment that substantially limits one or more of an individu
al’s major life activities.
These pages to be completed by treating professional.
Name and Licensure or Certification (including state): ___________________________________________
Degree: ______________________________________________________________________________________
Area(s) of Specialization: ______________________________________________________________________
Address of Practice: ___________________________________________________________________________
Daytime Telephone: __________________________________________________________________________
The information provided by you regarding the above-named student will be treated as confidential and will be
disclosed by the College only as necessary for assessment and/o
r implementation of the requested services or
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Bennington College | Provost and Dean’s Office | One College Drive, Bennington, Vermont 05201 | 802-440-4400
What is the specific diagnosis/impairment/limitation?
Disability: Please indicate if the student’s degree of impairment or limitation is such that it meets the
definition of
disability as described above. yes no
Describe the diagnostic methodology, including diagnostic criteria, evaluation methods and procedures, and
when pertinent,
testing dates and results.
Explain how the student is substantially limited as a result of the disability and describe the severity and
frequency of
the limitation.
What are your recommendations for accommodations based on disability and how will these recommended
accommodations address
the identified limitation(s) resulting from the disability?
Signature of Treating Professional: ________________________________________ Date: ____________
Note: For a
diagnosed Learning Disability (LD) or Attention Deficit Disorder/Hyperactivity Disorder (ADD/ADHD),
please enclose a recent psychoeducational evaluation including test scores and recommendations.
Bennington College | Provost and Dean’s Office | One College Drive, Bennington, Vermont 05201 | 802-440-4400
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