New Accommodation Request

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Student Accessibility Services


Nazareth College is committed to providing students with disabilities equal access to college programs, activities, and services. Students with documented physical, cognitive, or psychological disabilities, of both a temporary or permanent nature, are entitled to appropriate accommodations and services through the office of Student Accessibility Services. All accommodations are determined on a case-by-case basis.

Students interested in receiving accommodations will need to submit appropriate documentation to the office. Students should obtain disability-related documentation from qualified professionals stating the disability/diagnosis and explaining the functional impact of the disability on their academic situation. Documentation may include psychoeducational evaluations, IEPs, 504 Plans, and/or official letters from qualified professionals (such as doctors, therapists, and psychologists). Documentation can be submitted via this form, faxed to 585-389-2499, or emailed to

Please continue this form to begin the Accommodation Request process.

Student Information

Please enter your information
Please use your university issued email address
Do you work with a counselor at ACCES-VR or ABVI
Will you be seeking any campus-related accessibility considerations or accommodations?
(ex. special housing requests, medical alerts)

Disability Information

(ex: ADHD, Dyslexia, Epilepsy, Arthritis, Major Depressive Disorder)

Accommodations and Testing Center

Accommodation Agreement
I agree to the accommodations listed on my accommodation letter. If at any point I feel my accommodations are not being followed and/or I have concerns about my accommodations, I will contact SAS to discuss my concerns.

I will contact SAS at the beginning of each semester to obtain accommodation letters for my classes. Accommodations for a class are not in place until I hand my instructor my accommodation letter.

I understand that my accommodation letter is specific to Nazareth College and does not necessarily transfer from college to college

Testing Center Agreement
I assert that I have received a copy of the Testing Center policies and procedures. I agree to adhere to the policies and procedures listed.

Release of Informaton

Permission to Disclose InformationRequired

By clicking yes, you grant Student Accessibility Services permission to disclose information regarding your disability(ies) (not the specific diagnosis/es) to appropriate college personnel and affiliated agencies for the purpose of determining and arranging accommodations and those services necessary for meeting your educational needs.

I understand that I am responsible for submitting current documentation specific to my disability(ies). Upon receipt and consideration of such documentation, accommodations/services will be determined and discussed during an interview with the Director of Student Accessibility Services. In addition, I understand that provision of these accommodations/services may involve disclosing disability record information provided by me to appropriate college personnel participating in the accommodation process.


Are you planning on submitting documentation today?Required