Request for Accommodations Form

To request reasonable accommodations, complete this form, attach photocopies of all appropriate documentation described below or have them sent to the College of Nursing Attention to Dean of Students (contact information below), sign and date the attestation. If you have any questions regarding your request, contact the Dean for Students. Phone: 315-448-5040 Fax: 315-448-5745 Email: terry.pudney@sjhcon.edu Mailing Address: St. Joseph’s College of Nursing Attn: Dean of Students 206 Prospect Ave. Syracuse, NY 13203

Candidates requesting reasonable accommodations because of disabilities covered by applicable laws must provide photocopies of documentation according to these standards: 1. The documentation must be an evaluation and/or diagnosis by a licensed professional. The diagnosis must be within the professional's scope of practice. If testing was performed on the candidate, the results of those tests must be provided. 2. The documentation must be signed by the licensed professional on official letterhead from that person's practice. The professional must be clearly identified by name and profession. 3. The documentation must be from within the last three (3) years. 4. The documentation must state the diagnosis clearly and must specify what accommodations are required for the candidate to experience a fair educational experience. The accommodations must be presented as a requirement given the nature of the disability, not as a suggestion. 5. Documentation from a school psychologist is only acceptable if the candidate is still a student in that school system. IEPs and 504 plans from a candidate's secondary education or earlier are not acceptable because they are administrative documents, not the evaluations of licensed professionals, and they are not assessments of the candidate as an adult.

Attach Files

Attach Files

Attach Files

In addition to submitting this request, please note that it is your responsibility to meet with your faculty members and directly inform them that you will need academic accommodations in their course. In many instances, it will be most helpful for you to discuss your needs in more detail with individual faculty members. It is your decision alone whether or not to disclose to your instructors the specific nature of your disability (dyslexia, epilepsy, ADD, etc.). It is recommended that you advocate for yourself early in the semester/term, giving faculty time to make necessary changes in their course preparation, delivery or testing plans. This also helps faculty more clearly understand how they can best assist you. In addition, you can schedule an appointment with the Dean of Students to discuss your accommodations, and your Academic Advisor(s) may be an additional source of support as well. PLEASE READ AND SIGN: I declare and affirm that the statements made in this request, including accompanying documents, are true, complete, and correct and I understand that my request for accommodations will be based on a documented disability and the supporting documentation currently on file. Upon my request for notification, faculty, advisors, and staff will be notified only of the specific academic accommodations that should be granted (extended time, alternate test location, text to speech technology, etc.). The specific nature of my disability and the actual evaluation data will not be released unless specifically requested by me. This authorization for accommodation only applies to the current academic semester/term. This form must be completed each semester/term since faculty names and classes will change. Once all documentation is provided, you will review the accommodations with the Dean of Students prior to them being sent to any faculty members.

Clear