Student Access Services Request for Reasonable Accommodations
Student Access Services arranges accommodations for qualified students with disabilities. Students seeking accommodations complete this form, submit documentation of disability and participate in a Welcome Meeting with Student Access Services to engage in the interactive process. Request may take up to two weeks for approval after the Welcome Meeting and approved accommodations may take up to four weeks to implement. Students are encouraged to submit request as early as possible. Students in need of a reasonable accommodation or assistance in completing this application may contact Student Access Services at 575-835-6209. After this form is submitted you will be redirected to make an appointment with the SAS Director in order to complete your Welcome Meeting.
Full name
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First Name
Last Name
Preferred name
New Mexico Tech Email Official Correspondents will use NMT email
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example@student.nmt.edu
Student ID
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Phone Number
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Please enter a valid mobile/home phone number
The date of your first semester at NMT
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E.g. Fall 2020
Identify the semester for which you are seeking accommodations
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Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you currently live in NMT housing?
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Yes
No
NMT Housing Address for current resident
eg South Hall 116
Campus PO Box
eg. PO Box 2594
Preferred Pronoun
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She, Her, Hers
He, Him, His
They, Them, Theirs
Preferred Pronoun
Date of Birth
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Month
-
Day
Year
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Enrollment Status (select all that apply)
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I am an incoming first year
I am an incoming graduate student
I am a visiting student
I am a prospective student
I am an incoming transfer student
I am a current student
Area of Study
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How were you referred to Student Access Services?
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Dean of Student Success
Dean of Students
Family
Friend
Medical Doctor
Professor
Residence Life
Self
Student Health Services
Student Affairs
Other
Other important information:
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I am a client of vocational rehabilitation
I am an active service member or a veteran
I am an international student
I am on academic probation
I am returning from leave of absence
None of the above
Are you having any concerns regarding:
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Stress Management
Time Management/Organization
Workload
Planning
Other
Disability Category
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Executive/Learning
Blind/Low Vision
Deaf/Hard of Hearing
Chronic Health
Psychological
Temporary Injury
Other
What is your formal diagnosis?
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What was the most recent evaluation of your condition and who conducted the evaluation?
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Please provide your most recent documentation - we may request more information at a later date if necessary.
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Please provide supporting documents. If files are too large, please email to access@nmt.edu or fax 575-835-5899 Policy for documentation: https://www.nmt.edu/cds/docs/Office%20for%20Disability%20Services%20NMT%20DocumentationPolicy6-20.pdf
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Briefly describe why you are contacting Student Access Services.
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This is an accommodation request for:
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Academic
Housing / ESA
Academic & Housing / ESA
Temporary Disability (i.e. broken limbs, concussion, etc.)
I think I have a disability, but I have no diagnosis
Other
Please describe your disability and how it currently affects you.
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Have you ever received any accommodations in an educational setting and/or standardized tests?
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Yes
No
Please explain accommodations used
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Describe how your disability currently impacts your academic life.
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Which aspects of learning do you find the most challenging?
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Please list any New Mexico Tech resources you have utilized.
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Please list the accommodations that you feel are necessary to allow you to access our curriculum and community.
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Do you or have you used any adaptive technology or devices? If so, please describe what has been the most helpful.
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Are you seeking an ESA or Service Animal accommodation?
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Yes
No
Please check your email after completing this form for more information in regards to ESA/ Service Animal accommodations
Please check your email after completing this form for more information in regards to Housing accommodations
Describe how your disability currently impacts your housing.
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Please list the accommodations that you feel are necessary to allow you to access housing at New Mexico Tech.
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If you are requesting a single room as an accommodation for your disability or medically related condition, please describe the specific ways that sharing a room with another person does not address the functional limitations of your disability.
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Please include anything else you would like Student Access Services to know in order to best assist you.
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Please list any questions you have about our services that we can answer for you.
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Policies and Procedures
1) It is my responsibility to provide accurate and timely documentation to SAS. 2) It is my responsibility to check my student email for updates and announcements. 3) Once I have had a Welcome Meeting, the process can take up to four weeks to implement some accommodations. 4) It is my responsibility to request accommodations each semester. 5) I must notify SAS if I drop or add classes. 6) It is my responsibility to deliver my accommodation letters to my professor in a timely fashion. 7) If I am requesting a new accommodation, I may be required to provide updated documentation and meet with SAS. 8) It is my responsibility to communicate directly with my faculty regarding exam accommodations, and stay in communication about the time and place of such exams. 9) It is my responsibility to contact SAS in a timely fashion if I am having any difficulties in securing or arranging accommodations. 10) I am responsible for the condition and timely return of any equipment I use or borrow from SAS 11) If I am approved for Notetaking or Audio recording services, I understand that the notes and/or recordings are for my use ONLY and may not be shared. In addition, I understand that I will only receive these services when I am present. 12) Student Access Services does not provide retroactive accommodations. 13) Faculty are not required to provide any accommodation that fundamentally alters the nature of their course or lowers academic standards. 14) It is my responsibility to ask the professor of record whether other professors or academic personnel (such as course coordinators or teaching fellows) need to be informed of my approved accommodations. It is also my responsibility to inform those professors as well. 15) Failure on my part to carry out any of these responsibilities may result in my inability to secure accommodations.
Adding your name below indicates that you have carefully read, understood, and agreed to the policies of Student Access Services at NMT.
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