Fillable Steps for Requesting Disability Accommodation The Accessibility and (Azusa Pacific University)

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Steps for Requesting Disability Accommodation The Accessibility and (Azusa Pacific University)

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Steps for Requesting
Disability
Accommodation
The Accessibility and Disability Resources (ADR) staff coordinates a number of direct services for
undergraduate and graduate/professional students with disabilities. Accommodations are individualized based
on a documented disability and the functional limitations of each student.
Step One:
Complete a Request for Accommodations Application. Please make sure to complete every section. Incomplete
applications will not be reviewed. An online application can be found at https://www.apu.edu/academic-
success/services/accessibility/.
Step Two:
Along with your application, provide verification of a disability from a professional medical or mental health
provider. Please see page 2 for our documentation guidelines. Application and documentation may be
submitted in person or emailed to disabilityservices@apu.edu. You will receive an email if your documentation
is insufficient so that you can resubmit appropriately.
Step Three:
Once your application and documentation is complete, you will be contacted within 3-5 business days to attend
an intake meeting. Non-traditional students and those at Regional Campuses may schedule a phone or video
conference meeting.
Please be aware that not all accommodation requests will be approved. ADR staff will review the request and
refer students to appropriate resources if a disability related accommodation is deemed unreasonable.
The accommodation approval process may take several weeks. Upon approved accommodations, you will
receive an email with your official accommodation memo. Your memo will also be emailed to appropriate APU
faculty and/or staff.
Once accommodations are established, they are applied proactively rather than retroactively, so planning ahead is
very important. If you do not submit the required documentation within 30 days of applying, or the
documentation is insufficient, your application will become inactive. You may re-apply at any time.
Please keep this page for your reference.
1
Revised August 2019
Documentation
Guidelines
Psychological/Emotional
Documentation must be provided by a licensed mental health professional. If medication is required, an evaluation
from a psychiatrist is preferred. Documentation must be current (prefer within 3 years) and must be signed and
submitted on official letterhead that states your diagnosis and any limitations you are experiencing as a result of
your diagnosis.
Recommended documentation includes:
1. A clear statement of the diagnosis, including DSM-IV TR diagnosis and a summary of present symptoms
2. How the symptoms are limiting the student’s functioning
3. Impact of medications (if any) on the student’s ability to meet the demands of the postsecondary academic
and social environment.
4. Recommendations or observations to assist in determining accommodations
Learning Disabilities
Documentation must be a report that includes evaluation data and a summary of the disability along with
accommodation recommendations. Documentation must be current (prefer within 3 years). In addition to a report,
a signed letter from the evaluator should be submitted on official letterhead with his or her license number.
Recommended documentation includes:
1. A clear statement of the disorder, including DSM-IV TR diagnosis and a summary of present symptoms.
2. A summary of the assessment procedures and evaluation instruments used to make the diagnosis, and a
summary of evaluation results.
3. Impact of medications (if any) on the student’s ability to meet the demands of the postsecondary academic
and social environment.
4. Recommendations or observations to assist in determining accommodations
Chronic Illness/Physical Impairment
Documentation of disability/illness must be from a medical professional such as a physician or other medical
specialist with expertise in the area of the diagnosis. Documentation must be signed and submitted on official
letterhead that states your diagnosis and any limitations you are experiencing as a result of your diagnosis.
Recommended documentation includes:
1. A clear statement of the diagnosis
2. How the symptoms are limiting the student’s functioning
3. Impact of medications (if any) on the student’s ability to meet the demands of the postsecondary academic
and social environment.
4. Recommendations or observations to assist in determining accommodations
2
Revised August 2019
Request for Accommodations
Undergraduate (choose from drop-down): 20_____
Graduate (choose from drop-down) : 20_____
Name: __________________________________________________ APU ID: _ _____________________________ Cell Phone #: ____________________________
APU Email: ____________________________________________________ Regional Campus, if applicable: ________________________________________
Do you live on the Azusa campus? ☐ Yes ☐ No If yes, where? ____________________________________________________________________
Permanent Address:
_________________________________________________________________________________________________________________________
Major/Degree
: ____________________________________________ Expected date of graduation: ________________________
☐ Freshman ☐ Sophomore ☐ Junior ☐ Senior ☐ Graduate ☐ Non-traditional Undergraduate (professional)
Disability Information (If you need more space, please attach a separate sheet.)
Is your disability ☐ Temporary ☐ Permanent
Disability falls into the following category(ies):
☐ Psychological
☐ Hearing
☐ Chronic Illness
☐ Mobility
☐ Respiratory
☐ Learning
☐ Visual
☐ Neurological/Brain Injury
☐ Other, please specify: __________________________________________________________________________
Please describe what you understand about your disability:
Describe in detail how your disability affects you academically and
in daily life. Give examples of limitations you experience:
3
Revised August 2019
Describe the accommodations you are requesting and how they will alleviate your symptoms:
History of Accommodations
Have you used accommodations before? ☐ High School ☐ University ☐ Other:___________________________________________
Dates you have used accommodations in the past: _________________________(month, year) to _________________________(month, year)
What types of accommodations have you received in the past?
Please indicate who referred you to Accessibility and Disability Resources: ________________________________________________
RELEASE AUTHORIZATIONS
APU Accessibility and Disability Resources staff engages in an interactive and collaborative process with students in order to
determine eligibility for reasonable accommodations. Part of this process includes the submission and review of documentation
related to the reported disability or limitations. At times, additional information may be requested from treatment providers.
Documentation provided to the ADR is confidential and only shared with other offices or personnel at APU as necessary to put
accommodations into effect. The identification of your disability is kept confidential, however we may share the limitations as part of
the interactive process. Disability information may be released only with expressed written permission of the student (which may
include e-mail).
I understand that any authorizations I make here may be withdrawn by me at any time through a written, signed, and dated request
(which may be done via email) or in conference with an ADR staff member.
Yes No
I give permission to the ADR to obtain information related to my disability from my medical providers.
By signing, I agree to the above process:
Student Signature: _______________________________________________________________
Date: _________________________________________
Thank you for completing this request. Incomplete applications will not be reviewed. Please be sure you filled out every
section before submitting.
4
Revised August 2019
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Steps for Requesting Disability Accommodation The Accessibility and (Azusa Pacific University)

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Completed 17 August 2020

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