Request for Accommodations

Request for Accommodations

The Department of Student Affairs at the Art Academy of Cincinnati provides services and/or accommodations for students with health needs and/or disabilities in an effort to facilitate equal access to education opportunities. To determine eligibility for services and/or accommodations, current and comprehensive documentation regarding the physical or mental condition and its impact on the student’s functioning is required from a licensed medical professional qualified to diagnose and treat the particular condition(s).

Please complete the form below, answering the questions to the best of your ability. The better you can describe your needs, the more useful your accommodations will be to you.

If you have an IEP (Individualized Education Plan) or 504 plan that you believe sufficiently describes your needs, please attach your IEP to the end of the form. Please keep in mind that the accommodations you receive may not be identical to the accommodations in your IEP or 504 plan. If you have questions about this, or would like to have a conversation about your accommodations plan, email Megan Martin at the address above or visit S270.

If you DO NOT have an IEP, please attach documentation of your condition from a licensed medical professional. (For example, a letter on office letterhead, or other proof of your condition.)

Accommodation Requests for Fall must be submitted by August 15.

Accommodations Requests for Spring must be submitted by January 5.

Name of Student*

Student Email*

Date of Birth*

Date

Date of Diagnosis*

Date

A disability is defined as a physical or mental impairment that substantially limits one or more major life activities or major bodily functions. What barriers or impairments do you experience due to your condition? How does the barrier impact you, in terms of limiting major life activities or bodily functions? How has it impacted your classroom experience, or how do you foresee it impacting your classroom experience? *

What accommodations would be helpful? Check all that apply.*

Please describe why you have requested the accommodations above, including which barrier or impairment they will assist with and how. Your requests should be directly related to your specific documented condition.*

I would like to request a meeting with the Associate Director of Academic Success to further discuss my accommodations plan.*

YesNo

Student Signature. By signing below, you acknowledge that you have willingly shared the information above for the purposes of setting up an Accommodations plan at the Art Academy of Cincinnati.*

Date

Upload any additional documentation that will help AAC assess the student's need for accommodations. IEPs, 504 plans, and documentation from health or mental health providers are all acceptable forms of documentation. Documentation from mental health/medical professionals should include license number, phone number, email, and mailing address.

Return this form to Megan Martin, Associate Director of Academic Success, at mmartin@artacademy.edu