Support for Accommodation Request Form

Students requesting academic adjustments, accommodations, or auxiliary aids from Student Support Services and Disability Office at Central College are required to submit documentation of their disability to verify eligibility under the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act of 1973, and Central College’s policies.  We suggest that students initiate a request for services and/or reasonable accommodations by following these steps: 

The three major steps to requesting accommodations are:


1) Eligibility/ Diagnostic Statement

The diagnostic systems used by the Department of Education, The Area Education Agencies, The State Department of Rehabilitative Services or other State agencies and/or the current editions of either the Diagnostic Statistical Manual of the American Psychiatric Association (DSM-IV-TR) or the International Statistical Classification of Diseases and Related Health Problems of the World Health Organization (ICD) are the recommended diagnostic taxonomies.

A diagnostic/disability statement includes the nature of the disability and:

2) Formal Diagnosis and Date

When available include the formal diagnostic statement, the name of the professional evaluator with credentials (certification, licensure, and/or the professional training of individual(s) conducting the evaluation should be provided), and the date of the evaluation.  Please indicate if there is no formal diagnosis available. 

3) Basis of Determination

The diagnostic criteria and or diagnostic process used for the determination of disability should be noted. This description should include the specific results of diagnostic procedures, diagnostic tests utilized, and when it was administered.  Diagnostic methods used should be congruent with the disability and current professional practices within the field. Informal or non-standardized evaluations should be described in enough detail that a professional colleague could understand their role and significance in the diagnostic process.
Provide information about:

4) Current Functional Impact

The current functional impact of the disability should be described either explicitly or through the provision of specific results from the diagnostic procedures.  Information should be current, based on the typical progression of the disability, its interaction with development across the life span, the presence or absence of significant events (since the date of the evaluation) that would impact functioning, and the applicability of the information to the current context of the request for accommodations.

The description includes functional impact of the disability on:

A description of current treatments and medications   
A history of treatments and medications, noting significant and potential side effects that may impact physical, perceptual, behavioral or cognitive performance should be included.

5) Response to Instructional Intervention

A description of instructional interventions, assistive devices, accommodations and/or assistive services should be provided.   Include statements about their effectiveness in minimizing the impact of the disability for the individual.

6) Description of the expected progression or stability of the impact of the disability over time.

This description should provide an estimate of the change in the functional limitations of the disability over time and/or recommendations concerning the predictable needs for reevaluation.

7) History of Accommodations

Depending on the impact of the condition on the individual, a history of accommodations implemented and their effectiveness in minimizing the impact of the disability should be provided.  For individuals graduating from high school, a record of those accommodations used during eighth through twelfth grade and their effectiveness is most helpful.

8) Suggested Accommodations

Depending on the impact of the condition on the individual, a statement should be made regarding suggestions or recommendations for accommodations and supports that can help to provide full access.  

Recommendations may include:

As appropriate, recommendations for collateral medical, psychological, and/or educational support services or training that would be beneficial may also be included.

Recommendations from professionals with a history of working with the individual provide valuable information for the review process. They will be included in the evaluation of requests for accommodation and/or auxiliary aids. Where such recommendations are congruent with the programs, services, and benefits offered by the Central College they will be given deference. When recommendations go beyond services and benefits that can be provided by the College they may be used to suggest potential referrals to area service providers beyond Central College.

9) Signature

The signature of the professional (i.e. secondary special education teacher, transition coordinator) completing this form along with title/role and organization is included for reference.

10) Authorization of Release

The student should be involved in this process and document his/her authorization for the release of the information for the purpose of evaluating eligibility and accommodation requests by signing and dating the release. 

11) Student Written Response

The purpose of the student written response is to engage the student in the process of his/her transition and self-determination.   The response may be handwritten or word processed.

Sources of Information:

For high school students who received or are currently receiving special education services, the information requested may be contained in an assessment or in high school records.  Recent reevaluations containing assessments specific to transition will be one source of information. Seldom would the IEP contain all the information necessary to determine eligibility or need, but the IEP should contain pertinent information regarding current levels of functioning, goals, rates of progress, and accommodations determined to be appropriate in the secondary setting.

In higher education the review process includes an examination of the presented documentation to determine the functional limitation resulting from the disability and how that limitation impacts the goals and standards of the student’s program or course.

These guidelines were developed to assist students in obtaining the information needed to evaluate their accommodation request.  Questions may be addressed to the disability services provider at the institution of higher education in which the student is interested.