Form: Disability Accommodation Request ENG

Reasonable Accommodation Policy

Grace School of Theology will reasonably accommodate otherwise qualified individuals with a disability unless such accommodation would pose an undue hardship or would result in a fundamental alteration in the nature of its services, programs or activities, or in undue financial or administrative burdens. Changes in teaching techniques occur continually as instructors discover new ways to aid handicapped students. The term “reasonable accommodation” is used in its general sense in this policy to apply to employees, students, and visitors.

Student requests for reasonable accommodation should be addressed to the Global Programs and Admissions Department. A student must self-identify as an individual with a disability and provide appropriate diagnostic information that substantiates the disability. The Global Programs and Admissions Department will then assess the impact of the disability on the student’s academic program and record the required academic accommodations. Individuals who have complaints alleging discriminations based upon a disability may file them with the Dean of Global Programs and Admissions.

This form will be submitted to the Dean of Global Programs and Admissions.

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Birthdate*

MonthDayYear

Student ID #*

Student Status*

Incoming StudentCurrent Student

Please describe your disability and how it impacts your ability to function in an academic setting:*

Explain any current, relevant treatment or therapy:*

Are your registered for any of the following?*

Department of Rehabilitation ServicesBureau of EducationServices for the BlindNot Registered

What accommodation(s) are you requesting?*

Be as specific as possible, i.e., assistive technology, reading, interpreter, schedule changes, etc.

Please explain the reason for your specific request(s).*

Would you consider alternative accommodations if recommended and available?*

YesNo

Please upload any documentation that may be relevant.

Browse Files

This is not a requirement.

Confidentiality Statement

Students' paper and electronic information is considered confidential pursuant to FERPA and is kept secured. Information about disabilities and the use of accommodations is only used to arrange accommodations with other staff and faculty on a need to know basis and is not recorded on any Grace School of Theology transcripts. In accordance with FERPA, disability related documents will not be released to persons who are not school officials without written consent of the student, unless a FERPA exemption applies. Students have the right to review the contents of their files. For such requests, contact the Registrar or the office of Regulatory Compliance.

READ and SIGN before you SUBMIT

Accommodations are based on a student's self-report of a disability and appropriate documentation. Reasonable accommodations will be determined and approved only after an interactive Intake Meeting with the Dean of Global Programs and Admissions or his representative.

Signature: By signing this you are acknowledging that you have read and understand the Reasonable Accommodation Policy, Confidentiality Statement, and the Intake Meeting statement above.*

Sign using your mouse/cursor.

Disability Accommodation Request Form

Student Information

Disability Information