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.
_____ 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: ___________________________________________
_____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: ________________________________________
Please remember that this information is CONFIDENTIAL.
SUGGESTIONS for TALKING to a PROFESSOR about ACCOMMODATIONS
1. 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.
2. 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.
3. Show your accommodation form to the professor and leave a copy with him/her. Keep a copy for your own reference.
4. 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.
5. 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, Lisa Levy, Traci Belanger, or Jet Goldberg).
6. Be sure that the specific arrangements regarding your accommodations are clear to both you and your professor.
7. Be responsible about forms for notetakers and test accommodations that need to be arranged
8. 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.
9. If you need tutoring or mentoring, ask your professor for a procedure sheet to access those services or speak with your Disability Specialist.
REMEMBER:
Ask for assistance when you first realize you need it...don't wait.