1160 Camino Cruz Blanca | Santa Fe, New Mexico 87505 | 800-331-5232 | sjc.edu
Dear I
ncoming Student,
St. Joh
n’s College is committed to fostering an inclusive environment for all students where
diversity is valued in the pursuit of knowledge. Each student brings unique perspectives, abilities,
and skills which together form the greater community in which we live, work, and learn. Students
with disabilities are just one group of students that comprise our diverse community.
St. Joh
n’s College works with students seeking reasonable accommodations as outlined in the
Americans with Disabilities Act and Section 504 of the Rehabilitation Act including academic
accommodations, housing accommodations, and policy accommodations. If you would like
accommodations, please submit the attached Request for Accommodations form and
associated
documentation supporting your request to start the review process. Once you have
made a request and submitted the appropriate documentation, it will be reviewed and you will
receive an
email with information about next steps.
Students are not required to register for accommodations, identify themselves to any members
of
the College community as a person with a disability, or utilize accommodations they do not
need
or want. Accommodation requests are evaluated on a case-by-case basis within the
structure of
the College program. Accommodations are not retroactive, so it is important that
you seek
accommodations in a timely fashion to avoid unanticipated consequences.
Sho
uld you have any questions or would like to discuss your specific needs, please email me at
christine.guevara@sjc.edu.
Sin
cerely,
Chri
stine Guevara
Executive Director of Health and Wellness
1160 Camino Cruz Blanca | Santa Fe, New Mexico 87505 | 800-331-5232 | sjc.edu
Request for Accommodation
STUDENT INFORMATION
Name: Date:
Email: Home Phone: Cell Phone:
PLEASE ANSWER THE QUESTIONS BELOW:
Degree: Undergraduate Graduate Expected Graduation Year:
Please describe (1) your disability and (2) its anticipated impact on your academic and student life:
Please describe previous accommodations, including academic, residential, medical, therapeutic, facilities access,
technology, time adjustments, transportation, etc. :
1160 Camino Cruz Blanca | Santa Fe, New Mexico 87505 | 800-331-5232 | sjc.edu
CLINICAL DOCUMENTATION:
Name of Clinician/Evaluator: Phone/Email:
Address:
Name of Clinician/Evaluator: Phone/Email:
Address:
ANTICIPATED NEEDS:
Please check anticipated needs based on your documentation:
Please note this list is not exhaustive.
Access T
echnology
Alternative format course materials (e-text, hard copy, etc.)
Remote CART/ Sign Language Interpreter
Housing Accommodations (for students with disabilities)
Time adjustments
Other:
Please send/submit form and your clinical documentation to:
Christine Guevara
Executive Director of Campus Health
and Wellness
christine.guevara@sjc.edu
The information I have provided is accurate to the best of my knowledge. I authorize
Christine Guevara, Executive Director of Campus Health and Wellness to consult, as needed, with clinicians to
clarify documentation.
Student Signature
click to sign
signature
click to edit
1160 Camino Cruz Blanca | Santa Fe, New Mexico 87505 | 800-331-5232 | sjc.edu
Documentation Requirements
Learning/Cognitive Disabilities, including Attention Deficit/Hyperactivity Disorder
o
The letter must be written on letterhead, dated, signed and include the name, area of
specialty, and crede
ntials of the person writing the evaluation. Please note evaluations
from family memb
ers will not be considered.
o
Diagnostic overview (including specific diagnosis using DSM-5); a description of the
problem(s) reported by the stu
dent; relevant medical/psychological history; family
history; and, as approp
riate, a discussion of dual diagnosis. Academic and educational
history must be included.
o
Testing that demonstrates the limitation of a major life activity as a result of the
disability. Evidence of a s
ubstantial limitation to learning or other aspects of academic
performance must be app
arent. The domains to be assessed should include aptitude,
academic achievement (rea
ding, mathematics, and written and oral language) and
information proces
sing (short and long-term and sequential memory, auditory and
visual processing, proce
ssing speed, and executive functioning). Test scores should be
provided for all mea
sures and appropriate for an adolescent or adult population.
Testing must have occurred within the past three years.
o
Clinical Summary, containing the following components: an interpretation of the test
findings that lead to the dia
gnosis; a description of the effects of that diagnosis on the
student’s academic perfo
rmance; recommendations for specific accommodations with a
clear justification for how th
ose accommodations will mediate academic performance
difficulties.
Chronic Health Conditions/Physical Disabilities
o
The letter must be written on letterhead, dated, signed and include the name, area of
specialty, and crede
ntials of the person writing the evaluation. Please note evaluations
from family memb
ers will not be considered.
o
Diagnostic overview, including date of first onset, specific interventions, medications,
prognosis, and, as appro
priate, a discussion of dual diagnosis. Please note that vague
descriptions will not be su
fficient to evaluate the need for accommodations.
o
Testing that demonstrates the limitation of a major life activity as a result of the
disability. Evidence of a s
ubstantial limitation to learning or other aspects of academic
performance must be app
arent. Testing should be recent, as appropriate. If the
disability is long-stan
ding in nature, the letter must include the history of the diagnosis,
any evolution in prese
ntation, and the frequency of the functional limitation.
o
Clinical Summary, containing the following components: a description of the effects of
that diagnosis on the s
tudent’s academic performance; recommendations for specific
accommodations with a c
lear justification for how those accommodations will mediate
academic performance diffic
ulties.
Hearing Disability
o
The letter must be written on letterhead, dated, signed and include the name, area of
specialty, and crede
ntials of the person writing the evaluation. Please note evaluations
from family memb
ers will not be considered.
o
Diagnostic overview, including date of first onset, specific interventions, prognosis, and,
as appropriate, a dis
cussion of dual diagnosis.
o
Documentation should include a signed and dated audiological evaluation report or
audiogram (or both)
.
1160 Camino Cruz Blanca | Santa Fe, New Mexico 87505 | 800-331-5232 | sjc.edu
o
Clinical Summary, containing the following components: a description of the effects of
that diagnosis on the s
tudent’s academic performance; recommendations for specific
accommodations with a c
lear justification for how those accommodations will mediate
academic performance diffic
ulties.
Vision Disability
o
The letter must be written on letterhead, dated, signed and include the name, area of
specialty, and crede
ntials of the person writing the evaluation. Please note evaluations
from family memb
ers will not be considered.
o
Diagnostic overview, including date of first onset, specific interventions, prognosis, and,
as appropriate, a dis
cussion of dual diagnosis.
o
Documentation should include the results of a recent eye examine that outlines the
extent of the visio
n loss.
o
Clinical Summary, containing the following components: a description of the effects of
that diagnosis on the s
tudent’s academic performance; recommendations for specific
accommodations with a c
lear justification for how those accommodations will mediate
academic performance diffic
ulties.
Psychological/Psychiatric Disabilities
o
The letter must be written on letterhead, dated, signed and include the name, area of
specialty, and crede
ntials of the person writing the evaluation. Please note evaluations
from family memb
ers will not be considered.
o
Diagnostic overview (including specific diagnosis using DSM-5); a description of the
presenting sympto
ms; history of symptom onset; prognosis; and, as appropriate, a
discussion of dual dia
gnosis.
o
Medication management plan that includes side effects or treatment details that could
impact academic perform
ance, as appropriate.
o
Clinical Summary, containing the following components: a description of the effects of
that diagnosis on the s
tudent’s academic performance; recommendations for specific
accommodations with a
clear justification for how those accommodations will mediate
academic performance diffic
ulties.
Regardless of diagnosis, the documentation must substantiate a limitation of a major life activity based
on the identified disability(ies). Students are free to submit any additional information beyond what is
specifically outlined above (Individualized Education Plans/504 Plan, letters documenting prior
accommodations) but such information will not, in and of itself, meet the requirements for
documentation.
Any sub
mitted materials will remain confidential and will be shared only to the extent required to
determine appropriate accommodations or as required by law. Any other disclosures will require the
written authorization of the student.