New Accommodation Request

* indicates a required field

Student Accessibility Services

Introduction

Nazareth University is committed to providing students with disabilities equal access to its 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 sasoffice@naz.edu.

Incoming students will be able to request accommodations starting in April for summer start programs, June for the fall semester, and November for the spring semester.

Please continue this form to begin the Accommodation Request process.

Student Information

Please enter your information.
Must have full Naz ID number
Please use your university issued email address

Disability Information

(ex: ADHD, Dyslexia, Epilepsy, Arthritis, Major Depressive Disorder)
Is this a temporary disability?Required

(Ex. concussion, broken limb)

Please note, this form is not to be used to report short-term absences from class due to acute illnesses. If you're seeking to have instructors notified of a short-term absence, please contact the Office of Student Success at oss@naz.edu.

Do you work with a counselor at ACCES-VR or ABVIRequired
Do you have any medical alerts that are necessary for Campus Safety to know?Required
(Ex. severe allergy, emergency evacuation assistance needed in event of fire)

Accommodation Request Information

Are you requesting academic accommodations? Required
(ex. extra time for exams, reduced course load, etc.)
Are you requesting residential or dining accommodations? Required

(ADA accessible room, medical exemption from on-campus housing, ESA, etc.)

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 a staff member from the Office of Student Success. 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.

Documentation

Are you planning on submitting documentation today?Required