Disability Accommodation Form

To:___________________________________

Date:_________________________________

From:__________________________, Disability Specialist 

Phone: 603.668.2211, ext:_______________________

Re: Accommodations for:________________________

Class:__________________________

This student has documentation approving eligibility for accommodations in your class. He/she needs to meet with you privately to discuss and arrange for the following accommodations.
Please remember that this information is CONFIDENTIAL.
Thank you.

Table Code: (ODS) Office of Disability Services will arrange this accommodation.

Responsibility of student and faculty

____ Extended test time on timed tests only

____ Proctored test in reduced-distraction environment
          (private ___ small group ___)

____ Electronic test format (to be used with a sceen reader)

____ Computer for all written assignments, including tests

____ In-class technology allowed (laptop computer, calculator, tape recorder)

____ Note taking accommodation to augment student's own notes

• For confidential arrangements, student will privately pick up notes from faculty
• Note taker may use note taking paper, photocopy own notes, or use laptop

____ May need to leave during class due to documented medical needs

____ Other: ___________________________________________

Responsibility of Office of Disability Services

____Sign language interpreters, CART reporter

____ Captioning fo video, DVD (requires advanced request from faculty to ODS)

____ Transcription of audio materials: podcast, webcast, online video clips, etc.
          (requires advanced request from faculty to ODS)

____ Scribe for tests

____ Use of screen reader for tests    _____ face-to-face reader for tests

____ Alternate text format (audio, electronic, Braille, large print)

____ Early registration

____ Other

Student and faculty have reviewed this form

Date: _____________________

Student Signature: ________________________________________

Faculty Signature: ________________________________________

Suggestions for talking to a professor about accomodations

• Go to your professor's office hours or make an appointment to meet privately in the professor's office. Do not try to have this conversation before or after class. You deserve the privacy and the full attention of the professor.
• Explain that you are receiving services from the Office of Disability Services and that you have documentation of a disability on file in the ODS.
• Show your accommodation form to the professor and leave a copy with him/her. Keep a copy for your own reference.
• Explain how your disability affects you in this particular class. Have suggestions in mind for what can be done to help you best demonstrate your mastery of the material.
• If the solution to your situation is not obvious, involve your professor in problem solving with you. You also can involve the Disability Services Specialist with whom you work (Hyla Jaffe, Liz Henley, Dennis Green or Traci Belanger).
• Be sure that the specific arrangements regarding your accommodations are clear to both you and your professor.
• Be responsible about forms for notetakers and test accommodations that need to be arranged 
• If you do not feel that the professor's suggestions meet your needs, tell the professor that you will seek clarification from the Office of Disability Services and get back to him/her.
• If you need tutoring or mentoring, ask your professor for a procedure sheet to access those services or speak with your Disability Specialist.

Remember to ask for assistance when you first realize you need it...don't wait.