Academic Accommodations Continuance Request

Academic Accommodations Continuance Request

Use this form to let the Accessibility Office know whether you wish to receive academic accommodations for the coming semester and whether you want to meet to discuss them.
Name*

First Name Last Name
Lyon Email
@lyon.edu
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid mobile phone number.
Do you give permission to text your mobile number?*

YesNo
Most recent semester and year that you received academic accommodations at Lyon?*
Most recent semester that you received academic accommodations at Lyon?*

YesNo, I am completing my degree at the end of the current semesterNo, I am transferring to another school
I request to continue my academic accommodations for the following semester:*
Have you encountered any difficulties with the implementation of your current accommodations?*

YesNo
Do you want to meet to discuss modifying your academic accommodations in any way?*

YesNo
If you are requesting to modify your accommodations, please summarize what you are requesting. The Director of Academic Support will meet with you to discuss your request.
Are there any courses you want to exclude from accommodations for the selected semester? If you select yes, you will need to list them in the next box.*

YesNo
List any courses you want to exclude from your request for the semester selected above.
Grievance Policy
Any student who believes he/she/they has been subjected to discrimination on the basis of disability may file a grievance under this procedure. It is against the law for Lyon College to retaliate against anyone who files a grievance or cooperates in the investigation of a grievance.

Grievances must be submitted to the Director of Academic Support in the Office of Accessibility within 14 days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
A complaint must be in writing and contain the name, address, and other applicable contact information of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
The Director of Academic Support shall investigate the complaint. This investigation may be informal, but it must be thorough, affording all interested persons an opportunity to submit evidence relevant to the complaint. The Director of Academic Support will maintain the files and records of Lyon College relating to such grievances.
The Director of Academic Support will issue a written decision on the grievance no later than 30 days after its filing.
The person filing the grievance may appeal the decision of the Director of Academic Support by writing to the Provost within 14 days of receiving the decision of the Director of Academic Support. The Provost shall issue a written decision in response to the appeal no later than 30 days after its filing.
The availability and use of the grievance procedure do not prevent a person from filing a complaint of discrimination on the basis of disability with the US Department of Health and Human Services, Office for Civil Rights.
To avoid conflict of interest, grievances filed against the Lyon College Office of Accessibility and/or its representatives should be submitted to the Provost within 14 days of the date the person filing the grievance becomes aware of the alleged discriminatory action. The Provost shall issue a written decision in response to the grievance no later than 30 days after its filing.

Lyon College will make appropriate arrangements to ensure persons with disabilities are provided other accommodations, if needed, to participate in the grievance process. Such arrangements may include but are not limited to providing interpreters for the deaf, providing audio of material for the blind, or assuring a barrier-free location for the proceedings. The Director of Academic Support will be responsible for such arrangements.
Attestation, Permissions, and Releases
By signing below, you attest that all information in this intake form is accurate to the best of your knowledge. You attest further that you have read and understand Lyon College's Office of Academic Support and Accessibility Grievance Policy.

By signing below, I give the Office of Academic Support and Accessibility permission to contact the professors in courses in which I am registered in the selected semester regarding my requested academic accommodations.

By signing below, I
- attest that all information in this registration form is accurate to the best of my knowledge;
- attest that I have read and understand Lyon College's Office of Academic Support and Accessibility Grievance Policy;
- give permission to the Office of Academic Support and Accessibility to contact and discuss my condition and needs with appropriate college personnel including advisor(s), professors, Student Life Office personnel, Academic Services personnel, Athletic Department personnel, College counsel, and other parties deemed necessary by the Office of Academic Support and Accessibility to have a justified interest in providing me reasonable academic accommodations and modifications at Lyon College.
Please sign your name*

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Academic Accommodations Continuance Request

Grievance Policy

Attestation, Permissions, and Releases