Fill - Free fillable Section VI.D.11. Students with Disability Rights Procedures These (Lone Star College System) PDF form

Section VI.D.11. Students with Disability Rights Procedures

These procedures supplement and clarify Section VI.D.11 of the Lone Star College System

District Policy Manual (“Policy Manual”) last revised by the Board of Trustees on March 3,

2016—setting out the College’s policy for students with disability rights. The Policy Manual

controls when a conflict arises between it and the procedures below. These procedures were

last updated on June 23, 2016. The notice and comment period was open online to the public

from April 26, 2016 to May 26, 2016.

1. Scope of Procedures. The procedures below are intended to apply to College

students requesting disability-based accommodations covered in Section VI.D.11 of the

Policy Manual. The College recognizes and supports the principles set forth in federal and

state laws designed to eliminate discrimination against qualified individuals with

disabilities. The College believes in equal access to educational opportunities for all

individuals. The College makes reasonable accommodations, including furnishing auxiliary

aids and services, for qualified individuals with disabilities as required by law. These

procedures are the College’s default procedures. However, the College understands that each

person is unique and may require variations to these procedures to suit individual needs.

Variations to these procedures require consent from the College’s Executive Director of

Disability Services. College community members with questions or concerns regarding these

procedures should contact the College’s Executive Director of Disability Services or the Office

of the General Counsel.

2. Student Responsibility to Request Accommodation. Students must identify

themselves each semester as individuals requesting accommodation based on a qualifying

disability. “Accommodations” includes academic adjustments and requests for auxiliary aids

and services.

(a)

Students Requesting Accommodation for Placement Test(s). Students needing

accommodation before a placement test must provide at least three working days’ notice

to the Disability Services Office (“DSO”) at the college hosting the placement test. Every

effort will be made to provide services for late requests. This section only applies to

students needing placement test accommodation; not for classroom accommodation

requests.

(b)

Students Requesting Accommodation for On-Campus Meetings. Students

needing accommodation for on-campus meetings must provide at least three working

days’ notice to the DSO at the college hosting the on-campus meeting. Every effort will be

made to provide services for late requests. This section only applies to students needing

accommodation for on-campus meetings; not for classroom accommodation requests.

(c)

Students Requesting Classroom Accommodation at Lone Star College for the

First Time. In order to be considered eligible for classroom accommodation, students

must provide notice and documentation of their disability to the DSO at the college in

which they are enrolled. The College has a two-step procedure to reasonably

accommodate students with qualifying disabilities. Step (1) certifies the student’s

qualifying disability and step (2) determines the student’s reasonable accommodation.

This procedure is meant to be interactive, deliberate, and collaborative between the

College and the student. It is not meant to be burdensome, but it can take time—students

are strongly urged to begin the procedure as soon as registration opens and at least four

weeks before classes begin. By starting early, students are more likely to timely receive

accommodations. The DSO accepts and considers requests for accommodation on a

rolling basis throughout each semester. However, late requests, incomplete

documentation, or failure to complete both parts of the procedure may result in

accommodation request denial or delays in implementing accommodations. The

College does not retroactively provide accommodations.

1. Certifying the Student’s Qualifying Disability. In order for a student to become

eligible to receive accommodation through the College, the student’s qualifying

disability must first be certified through documentation submission and verification

as described below.

A. Submitting Disability Verification Documentation to the DSO. At least four

weeks before classes begin, students should ensure they have current disability

verification documentation from a licensed or certified health care professional

qualified to treat and diagnose their disability. Please note that K-12 school

documentation may not be sufficient for post-secondary documentation

requirements. Current documentation typically means no more than five years old

but can vary depending on the nature of the disability. If students do not have

current documentation, the College recommends they use the College’s Disability

Verification Form (Form 1).

There are multiple ways to acquire the qualifying

disability documentation. All students must submit the Student Information &

Disability Accommodation Request (Form 2). In addition to the Student

Information & Disability Accommodation Request, students must also submit at

least one of the following:

College’s Disability Verification Form (Form 1) - Must be

completed by a licensed or certified healthcare professional

qualified to treat and diagnose the student’s disability.

Healthcare Professional Letter – The licensed or certified

healthcare professional can submit a signed and dated letter

of their own on letterhead which must include: (1) a

diagnostic statement identifying the disability and the

Students with apparent disabilities are asked to contact their college DSO directly to inquire as to whether

they will need to submit medical documentation. All students must submit the Student Information &

Disability Accommodation Request (Form 2).

The College’s Disability Verification Form provides information and forms the students can deliver to his or

her health care provider to document the qualifying disability.

diagnosis date; (2) the disability’s severity; (3) the

medication currently prescribed if any; and (4) the

recommended accommodations, if any, that may assist the

student in minimizing the condition’s impact in an academic

setting.

Full Evaluation/Diagnostic Report (Ex. – ETR, MFE)

Once students acquire the necessary medical documentation and complete the

Student Information & Disability Accommodation Request Form (Form 2), they

must submit both via fax, email, or personal delivery to the applicable DSO. The

College recommends that students follow up with their DSO to ensure the DSO has

all necessary paperwork to certify their eligibility to receive accommodation.

B. Submitted Documentation Reviewed and Certified by a DSO Provider.

After the DSO receives the documentation, a DSO provider will review. If the DSO

provider determines that the submitted documentation certifies that a student

has a qualifying disability, the DSO provider will confirm with an email to the

submitting student. The certification email from the DSO provider will be sent to

the student’s College designated email account (i.e., janesmith@my.lonestar.edu).

Students may request an alternate means of communication in their original

submission. The email will instruct the student to schedule an appointment with

a DSO provider. The College and student complete the first step of the two-step

procedure once the College send the student that email.

C. Submitted Documentation Reviewed and Not Certified by a DSO Provider.

If the documentation submitted is not approved, the DSO provider will send the

student an email with instructions on how to provide sufficient documentation

and contact information for follow-up questions.

2. Determining the Student’s Reasonable Accommodation. Once students receive

their certification email and schedule their appointment, then step two of the two-

step procedure can begin. In step two, the College and student work together to help

the College determine the reasonable accommodation. Students must complete step

two of the procedure to receive accommodation.

A. Schedule and Attend the Intake Appointment with a DSO Provider. Once a

student receives the certification email approving their documentation, they must

immediately schedule an intake appointment with a DSO provider. Students who

have registered for classes must bring their class schedule to the intake

appointment. During the intake appointment, the student and the DSO provider

will discuss the documentation submitted, barriers the student experiences,

reasonable accommodations best suited for the student, and how to set up those

accommodations. An accommodation will not be considered reasonable if it

fundamentally alters the nature of a service, program, facility, or activity of the

College.

Please note that certain types of accommodation will require the student to sign

additional forms (i.e., Agreement for Interpretive Services, Agreement to Audio-

Record Lectures, etc.).

B. Providing the Accommodation Letter to Professors/Instructors. Once the

reasonable accommodation is determined, students will receive an

accommodation letter for that semester specifying the accommodation(s). The

letter may be provided immediately after the intake appointment or in the days

following the appointment. The letter may also be emailed to the student’s College

designated account. Once students receive their accommodation letter, they must

sign the letter before giving it to class instructors. Students wanting to use their

accommodations in class must bring the signed accommodation letter to each

class they intend to use the accommodation(s). The instructor for each class must

then sign the accommodation letter and, subsequently, give the signed

accommodation letter to the DSO provider via email or interoffice mail. Ideally,

students give their accommodation letter to instructors on the first day of class.

Students are expected to be their own self-advocates. However, students are

reminded that the DSO providers can help students advocate for themselves and

their accommodations if desired. The College recommends students discuss the

accommodation with their instructors in addition to giving them the letter to

ensure the accommodations are understood and appropriately implemented.

Students are not required to disclose the nature of their disability to the

instructor. If students encounter any difficulty with their accommodation, its

implementation, or acquiring instructor signature, they should notify the DSO

provider immediately.

There may be circumstances in which a student’s accommodation is determined

to fundamentally alter the nature of a College course or program. In such a case,

the accommodation is considered unreasonable. Either the student or instructor

will immediately notify the DSO provider if an accommodation is considered to

fundamentally alter a course. The DSO provider will determine what adjustment,

if any, needs to be made to the student’s accommodation.

Students need not give a class instructor the accommodation letter if they decide

not to use their accommodation for that class.

(d)

Returning Students Requesting Previous Accommodation(s): Returning

students who previously completed the two-step procedure of certifying the qualifying

disability and determining the reasonable accommodation must request accommodation

each semester they wish to receive their approved accommodation(s). Returning

students do not have to repeat the entire procedure. To request the previously granted

accommodation, students must simply submit their class schedule and a Request for

Continued Services (Form 3) to the DSO provider. The DSO provider will contact students

if a problem arises with an accommodation for a specific class. However, if students

request changes to previously approved accommodations, then updated documentation

may be required.

1. Same Accommodation(s). If the returning student’s disability has not changed and

the student plans to use the same accommodation(s) previously granted, the student

must submit a class schedule and the Request for Continued Services (Form 3) to the

DSO provider at least one week before classes begin. The student may submit via fax,

email, or personal delivery. The DSO provider will review and, if permissible, a new

signed accommodation letter for that semester will be emailed to the student. The

student must sign the accommodation letter before giving it to the applicable class

instructor(s) for their signature. The instructor then signs the letter and emails it to

the DSO provider afterward.

2. Change in Disability or Change in Accommodation(s). Changes in a student’s

disability or accommodation may require additional documentation.

(i) Students desiring changes to their accommodations will need to

schedule an appointment with a DSO provider to ensure their eligibility for

that accommodation based on the documentation previously submitted.

(ii) Students experiencing changes in their disabilities requiring

additional or different accommodations may be required to give additional or

updated documentation.

Students are urged to submit the Request for Continued Services (Form 3) along with

any additional documentation they may have to the DSO at least four weeks before

classes begin. A new accommodation letter will be given to the student once the DSO

approves any changes. The student must sign the accommodation letter before giving

it to the applicable class instructor(s) for their signature. The instructor then signs

the letter and emails it to the DSO provider afterward.

(e)

Online Students. Students only enrolled in online classes must request

accommodation in the same manner as students taking classes on the College’s premises.

Students should, if applicable, request accommodation from their home college which is

detailed in their mylonestar account page. Students must still schedule the required

appointments with the DSO provider. However, these appointments may be done via

telephone, video conference, or in another format that suits the DSO provider and

student. Once the student receives the accommodation letter, the student must still sign

the letter and then email it to the online instructor for the courses in which the student

desires accommodation. The instructor then signs the letter and emails it to the DSO

provider afterward. Students are urged to follow-up with the instructor regarding the

accommodation and determine whether technical support will be needed to implement

the accommodation.

(f)

Multi-Campus Students: Students enrolled at multiple campuses during a semester

should, if applicable, request accommodation from their home college which is detailed

in their mylonestar account page. Additional DSO providers may need to be involved with

multi-campus students especially with regard to specific facility accommodations at

different colleges.

(g)

Auxiliary Aids and Services. Students requesting auxiliary aids and services such as

interpreting or notetaking services must have completed the two-step procedure with

the DSO. Because many of the offered auxiliary aids and services are scheduled based on

students’ class schedules, the College urges students to register for classes early and

complete the two-step procedure to ensure that services are scheduled before classes

begin. Every effort will be made to provide services for late requests. All students

receiving auxiliary aids and services will receive additional instructions from the DSO

provider.

3. Requests for Reconsideration or Revision of Accommodations and

Discrimination Complaints.

(a)

Requests for Reconsideration of Accommodation Denial and/or College-

Proposed Accommodation. Students may appeal denied accommodations by

submitting a Request for Reconsideration (Form 4) within two weeks of the College

denying an accommodation request. The Request for Reconsideration shall be submitted

to the Executive Director of Disability Services. Once a student has timely submitted his

or her Request for Reconsideration, the Executive Director of Disability Services will

review and make a determination within five working days. Students may appeal the

Executive Director of Disability Services’ decision in the manner described in Section

VI.D.12 (Student Civil Rights Complaints). Students may appeal College-proposed

accommodations in the same manner.

(b)

Requests for Accommodation Revisions. After a student is certified as having a

qualifying disability and the accommodation is implemented, the student may determine

the accommodation needs revision at some point during the semester. Any revision

desired by the student must be approved by the DSO; the instructor does not have the

authority to change the accommodation. The DSO may determine that a conference with

the instructor and student is necessary to determine what accommodation will work best

for the student in that course. If the revision is approved by the DSO, the student and

instructor must sign the revised accommodation letter and return it to the DSO.

(c)

Complaints. Students encountering difficulties or disputes related to their disability

or accommodations are encouraged to contact their DSO and the Executive Director of

Disability Services as soon as practicable to resolve the dispute informally if possible. A

DSO provider will discuss the student’s concerns and provide options to help the

dispute’s resolution.

If the student is unsatisfied with the informal dispute resolution, or if it is unreasonable

to resolve the issue informally, the student may submit a complaint in the manner

described in Section VI.D.12 (Student Civil Rights Complaints). The Executive Director of

Disability Services will be included in all Student Civil Rights Complaints alleging

disability discrimination unless the Executive Director is the respondent to the

complaint.

1. Academic Appeal citing Accommodation Implementation. Students are

encouraged to discuss accommodation implementation problems with their

DSO. Student unable to informally resolve an academic issue related to their

accommodation implementation, i.e. a request to change a grade, or to

challenge a penalty imposed for violation of standard of academic integrity,

may file an Academic Appeal (Board Policy section V.C.3).

Any College personnel receiving an Academic Appeal citing improper

accommodation implementation shall notify the Executive Director of

Disability Services. The Executive Director of Disability Services shall provide

a recommendation to the Chief Academic Officer or the Academic Appeals

Committee. The Chief Academic Officer or the Academic Appeals Committee

shall consider the recommendation provided by the Executive Director of

Disability Services. Once the Chief Academic Officer or the Academic Appeals

Committee makes a decision, the Chief Academic Officer will inform the

Executive Director of Disability Services.

Students may also file a complaint at any time with the regional Office of Civil Rights at

the U.S. Department of Education or through the civil court system.

(d)

Prohibition of Retaliation or Coercion. The College prohibits any College

community member from retaliating against any individual because that individual (i)

opposed any act or practice made unlawful by applicable laws or this policy or (ii)

submitted a complaint, testified, assisted, or participated in any investigation,

proceeding, or hearing under applicable law or this policy. College community members

who violate this policy will be disciplined accordingly. Any individual experiencing

retaliation or coercion is asked to contact the DSO and the Executive Director of Disability

Services immediately.

4. Responsible Employee Designation. Appendix A includes the names and contact

information for the College’s Responsible Employee Designee as well as the contact

information for each college DSO.

Effective Date: June 27, 2016

Dr. Stephen C. Head

Lone Star College

APPENDIX & FORMS

APPENDIX A

(a)

Executive Director of Disability Services.

Kristin A. Malloy MSW

5000 Research Forest Drive

Office WLB 163

The Woodlands, TX 77381

Office: 832.813.6633

Fax: 832.813.6730

Kristin.A.Malloy@LoneStar.edu

(b)

The College’s Disability Services Offices.

LSC-Cy-Fair, LSC-Cypress Center, and LSC-Fairbanks Center

Stephanie Dillon

LSC-CyFair

9191 Barker Cypress Road

Cypress, TX 77433

Office: CASA 109H

Phone: 281.290.3260

Fax: 281.290.5289

Stephanie.G.Dillon@LoneStar.edu

LSC-

Houston North

Marilyn Martin

LSC-Houston North

4141 Victory Drive

Houston, TX 77088

Office: Victory 106

Phone: 281.260.3522

Marilyn.A.Martin@LoneStar.edu

LSC-Kingwood, LSC-EMCID Center, and LSC-Atascocita Center

Lee Ann C. Liebst

LSC-Kingwood

20000 Kingwood Drive

Kingwood, TX 77339

Office: SCC 205

Phone: 281.312.1453

Fax: 281.312.1559

LeeAnn.C.Liebst@LoneStar.edu

LSC-Montgomery and LSC-Conroe Center

Vicky Saunders

LSC-Montgomery

3200 College Park Drive

Conroe, TX 77384

Office: C-221A

Phone: 936.273.7239

Fax: 936.273.7207

Victoria.A.Saunders@LoneStar.edu

LSC-North Harris, LSC CHI Institute, LSC-Health Professions Building, and LSC

Transportation Institute

Michelle Barksdale

LSC-North Harris

W.W. Thorne Drive

Houston, TX 77073

Office: Winship, WN-120C

Phone: 281.765.7938

Fax: 281.618.5763

Michelle.M.Barksdale@LoneStar.edu

LSC-Tomball, LSC-Tomball Health Science Building, and LSC-Creekside Center

Carolyn L. Williams

LSC-Tomball

30555 Tomball Parkway

Tomball, TX 77375

Office: C100G

Phone: 281.357.3777

Fax: 281.351.3303

Carolyn.L.Williams@LoneStar.edu

LSC-University Park and LSC Energy & Manufacturing Institute

Jennifer Crawford

LSC-University Park

20515 SH 249

Houston, TX 77070-2607

Office: Bldg. 13, Room 220B

Phone: 281.401.5366

Jennifer.Crawford@LoneStar.edu

LSC-Greenspoint Center

Marilyn Martin

LSC-Greenspoint Center

250 N. Sam Houston Pkwy E.

Houston, TX 77060

Office: Greenspoint 314

Phone: 281.260.3522

Marilyn.A.Martin@LoneStar.edu

LSC-Victory Center

Marilyn Martin

LSC-Victory Center

4141 Victory Drive

Houston, TX 77088

Office: Victory 106

Phone: 281.260.3522

Marilyn.A.Martin@LoneStar.edu

Disability Verification Form (Form 1)

Page 1 of 5

DISABILITY VERIFICATION FORM (Form 1)

Medical Provider Verification

Dear Health Care Professional,

One of your patients is a student at Lone Star College requesting a disability-based academic

accommodation. Accommodations are made for qualified students with a disability in order for

them to equally participate in all programs and services offered by the College to ensure

compliance with all applicable disability laws. In order for the Disability Services Office to

determine the student’s accommodation eligibility, we need your clinical assessment/diagnosis of

the student. You may fax us a copy, but our records must include an original with your signature

and business card. In addition to the form provided, you may provide supplemental information

on your letterhead.

In order for the student to be certified as eligible, the documentation must show how the disability

substantially limits one or more major life activities. Current and relevant information is required

in order to determine the appropriate reasonable accommodation that may be offered to the student.

All information should be completed by a medical provider qualified to diagnose and treat

the student’s disability.

Please provide the following:

A completed and signed Provider Verification packet for each disability and

Staple your business card to each Provider Verification packet.

The information you provide will be kept confidential in accordance to the Family Education

Rights and Privacy Act (FERPA) and may be released to the student upon written request for

records.

If you have any questions regarding this form or opportunities for the student, please contact

Disability Services at the information listed below. We may also contact you directly for

supplemental information if necessary to make a determination.

Thank you for your assistance,

*The Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits employers and other entities covered by

GINA Title II from requesting or requiring genetic information of an individual or family member of the individual

except as specifically allowed by this law. To comply with this law, we are asking that you not provide any

genetic information when responding to this request for medical information. “Genetic information”, as defined

by GINA, includes an individual’s family medical history, the results of an individual’s or family member’s genetic

tests, the fact that an individual or an individual’s family member sought or received genetic services, and genetic

information of a fetus carried by an individual or an individual’s family member or an embryo lawfully held by an

individual or family member receiving assistive reproductive services.

Disability Verification Form (Form 1)

Page 2 of 5

I, , authorize my medical provider to release to Lone

Printed Student Name

Star College’s Disability Services Office the medical information requested on this form for the

purpose of determining appropriate accommodations for my disability while a student at Lone

Star College.

Patient Signature: Date:

Student Signature

Provider Verification of Physical/Medical Disability

Student Name: Student ID:

To the Student: The form below the line must be completed by your medical provider who is

qualified to diagnose and treat your disability. The Disability Services Office reserves the right to

request additional documentation or contact your provider for additional information. If this form

is completed by anyone other than a qualified licensed professional, the information will not be

used to support your accommodation request. Inaccurate and incomplete documentation may

hinder the College’s ability to accommodate you based on its policies and procedures.

Please sign the box below to give your medical provider authorization to release information to

the Disability Services Office.

TO BE COMPLETED BY MEDICAL PROVIDER

Is the student currently under your care? No Yes If yes, for how long?

What is the diagnosis/impairment/condition? (Please describe and use ICD 10 diagnostic codes

and or APA DSM 5)

Date(s) of Onset:

Disability Verification Form (Form 1)

Page 3 of 5

FUNCTIONAL LIMITATION CHART

Reminder: Please identify functional limitations without regard for mitigating measures (i.e.,

medications). For intermittent conditions, assess functional limitations based on a picture when all

symptoms are active. Use an “X” to indicate level of impact on major life activities.

Major Life

Activities

No Impact

Moderately

Impacts

Substantially

Impacts

Unknown

Communicating

Concentrating

Hearing

Learning

Manual Tasks

Reading

Seeing

Thinking

Walking

Working

Sitting

Other:

What are the specific functional limitations resulting from the disability’s impact on the major life

activities in a learning environment (e.g. unable to handle stairs, miss class due to side effects from

disability or medication, unable to sit for long periods of time)?

Are the functional limitations permanent? No Yes If no, what is the anticipated date of

resolution?

Is the student currently undergoing treatment? No Yes If yes, please describe the type

of treatment and list any medications and possible side effects that may affect the student in an

academic setting:

Disability Verification Form (Form 1)

Page 4 of 5

FUNCTIONAL OR BEHAVIORAL PRESENTATION CHART

Please use an “X” to indicate additional limitations or behavioral manifestations.

Limitations and Behavioral

Manifestations

Not an Issue

Moderate

Issue

Substantial

Issue

Unknown

Cognitive Processing

Memory

Processing Speed

Meeting Deadlines

Attending class

Organization

Reasoning

Stress

Sleep

Appetite

Other:

What are the specific behavioral limitations resulting from the disability’s impact on the major life

activities in a learning environment?

Are the behavioral limitations permanent? No Yes If no, what is the anticipated date of

resolution?

Is the student currently undergoing treatment? No Yes If yes, please describe the type

of treatment and list any medications and possible side effects that may affect the student in an

academic setting:

Disability Verification Form (Form 1)

Page 5 of 5

PLEASE ATTACH

BUSINESS CARD

HERE

Medical Provider Information:

First Name: Last Name:

Title: State License Number:

Address: City: State:

Zip: Phone: Fax:

Physician/Provider Signature: Date:

Student Information & Disability Accommodation Request (Form 2)

Page 1 of 2

STUDENT INFORMATION & DISABILITY ACCOMMODATION REQUEST (Form 2)

Accommodations Requests also include requests for Auxiliary Aids and Services

Student Information:

Name:

Student ID: Date of Birth:

Address:

Primary telephone: Email:

Do you give permission to leave confidential information on voicemail? Y N

Would you like to receive email updates and reminders from our office? Y N

Emergency Contact Information (optional):

Are you currently enrolled at Lone Star College? Y_N

If yes, check campus:

 Cy-Fair

 Kingwood

 Cypress Center

 Montgomery

 North Harris

 Process Technology Center

 East Aldine Center

 Tomball

 Creekside Center

 University Park

 Conroe Center

 EMCID Center

 Greenspoint Center

 Fairbanks Center

 Victory Center

 Atascocita Center

 Houston North

 Westway Park Technology Center

If no, when will you enroll and where? _

Career Goal or Major:

Disability Information:

What is your disability or disabilities?

Check All That Apply:



Learning Disability



Asperger’s/Autism



Deaf/Hard of Hearing

 Ment

al Health

 Blind/Low Vision

 Traumatic Brain Injury

 Physical/Mobility

 Other

What accommodations will assist you in your academic life?

Check all support you receive and list corresponding contact information:



DARS (Department of Assistive and Rehabilitative Services)



MHMR (Mental Health Services)



OTHER

Agency Name:

Contact Name:

Telephone:

Agency Name:

Contact Name:

Telephone:

Date_

Semester

Year _

Student Information & Disability Accommodation Request (Form 2)

Page 2 of 2

For Disability Services Office Use Only:

Did student provide and attach requested documentation to be eligible for accommodation? Y N

If no, was student provided with a Disability Verification Form and reminded of his or her responsibility to obtain said

documentation prior to being eligible for accommodation? Y N

Did Disability Services provider and student discuss the student’s class schedule and specify which courses he or she

desired accommodation(s) for? Y N

DSO Provider: Date:

STUDENT AGREEMENT REGARDING DISABILITY ACCOMMODATION REQUESTS

Please read carefully and initial each statement below indicating your agreement:

I understand that I must submit a request for accommodation and provide requested documentation of my disability

to the Disability Services Office at the college where I am enrolled in order to be eligible to receive accommodation(s).

I understand that accommodation requests with approved documentation may take 2-4 weeks to be processed and, if

possible, implemented by the College.

I understand that, for the Disability Services Office to provide effective accommodation(s) for me, information related

to my enrollment, courses, and disability will be used by the Disability Services Office for purposes of preparing or

providing reasonable accommodation.

I consent to the College’s Disability Services Offices communicating regarding my disability as it pertains to my

accommodations, educational needs, and progress.

I consent to the Disability Services Offices communicating with my instructors regarding proposed or approved

accommodation(s), my educational needs, and progress reports as needed. Unless specifically requested in writing, the

Disability Services Office will not communicate my disability outside of personnel in the College’s Disability Services

Office.

I understand that I must meet with the Disability Services Office each semester I am enrolled to be eligible to receive

accommodation(s).

Student Signature Date

Request for Continued Services (Form 3)

Page 1 of 2

STUDENT REQUEST FOR CONTINUED SERVICES (Form 3)

This Form is for students who have previously completed the College’s two-step process for receiving accommodation from the Disability Services

Office (DSO). If you have not completed the College’s two-step process, please use the Student Information & Disability Accommodation Request

(Form 2). Please note that submission of this form does not automatically grant accommodation. Once submitted, a DSO provider will review this

Form and determine whether you are eligible for accommodation. Eligible students will receive an accommodation letter from the DSO for the

current semester.

Student Information:

Name: Today’s Date:

Student ID: Date of Birth:

Address:

Primary telephone: Email:

When did you receive accommodation at Lone Star College? Semester Year

College of enrollment:



Cy-Fair



Kingwood



Cypress Center



Montgomery



North Harris



Process Technology Center



East Aldine Center



Tomball



Creekside Center



University Park



Conroe Center



EMCID Center



Greenspoint Center



Fairbanks Center



Victory Center



Atascocita Center



Houston North



Westway Park Technology Center

Disability Information:

Has your disability changed? Y N

If Yes, please explain:

Are you submitting updated documentation? Y N

Are you requesting the same accommodation(s) previously granted by the College? Y N

If No, please explain:

Is your current class schedule attached? Y N

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Request for Continued Services (Form 3)

Page 2 of 2

For Disability Services Office Use Only:

Did student attach class schedule? Y N

Are student’s previously provided accommodations reasonable for the current classes? Y N

Did student have a change in disability? Y N

If yes, did student provide additional or updated documentation? Y N

Did student request a change in the previously provided accommodation(s)? Y N

If yes, does the change requested require additional or updated documentation? Y N

DSO Provider: Date:

STUDENT AGREEMENT REGARDING DISABILITY ACCOMMODATION REQUESTS

Please read carefully and initial each statement below indicating your agreement:

I understand that I must submit a request for continued services to the Disability Services Office to be eligible to

receive previously granted accommodation each semester.

I understand that changes to my disability or my previously granted accommodation may require me to provide

additional or updated documentation.

I understand that changes to my disability or my previously granted accommodation may take 2-4 weeks to be

processed and, if possible, implemented by the College.

I understand that, for the Disability Services Office to provide effective accommodation(s) for me, information related

to my enrollment, courses, and disability will be used by the Disability Services Office for purposes of preparing or

providing my reasonable accommodation.

I consent to the College’s Disability Services Offices communicating regarding my disability as it pertains to my

accommodations, educational needs, and progress.

I consent to the Disability Services Offices communicating with my instructors regarding proposed or approved

accommodation(s), my educational needs, and progress reports as needed. Unless specifically requested in writing, the

Disability Services Office will not communicate my disability outside of personnel in the College’s Disability Services

Office.

Student Signature Date

Request for Reconsideration (Form 4):

This request must be sent to the Executive Director of Disability Services

Student:

Print Name

Student ID:

Disability Services Office:

College campus

This Request for Reconsideration is for (circle one):

Accommodation Denial or College-proposed Accommodation

---------------------------------------------------------------------------------------------------------------------

Request for Reconsideration – Please describe the circumstances of your request for reconsideration.

Attach all relevant documentation including the Disability Services Office denial of accommodation or

your accommodation letter.

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Section VI.D.11. Students with Disability Rights Procedures These (Lone Star College System)

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