Accommodations Request Form

Request for Academic Accommodations

This survey begins the process of...

1. Identifying your needs

2. Determining the best support to meet them

The input you provide as the expert of your experience is valued.

-Smartphones should use landscape view for best experience.-

Follow this link to view a narration of the "Academic Accommodations Request Process for SAGU" document.

Please note: This link should open in a new tab. This link is NOT the request form. You must return to this request form to complete the accommodations request process.
Only Nelson University Students May Request Accommodations

If you are a future student seeking information about accommodations,

Contact Us Now

or

Contact us later using the information below:

Academic Accommodations

- Phone: 972-825-4841

- Email: academicaccommodations@nelson.edu

- Fax: 972-923-8188

- In-Person: Learning Centers located in the Davis Building
MyNelson Address
firstmlast@my.nelson.edu (Example: Judah Nelson Lion- judahnlion@my.nelson.edu
Legal Name*

First NameMiddle InitialLast Name
Do you go by another name than your first name?*

NoOther
Birth Date*

MonthDayYear
Cell Phone Number:*
We will use this to contact you going forward. To protect your privacy we cannot use texting.
Message preferences:*

Voice messages: Leave only callback informationVoice messages: Leave a detailed messageLeave no voice messages and contact by MyNelson
Is your primary language English?*

YesNo
What is your primary language?*
What language do you speak with your family?
Where are you from?*

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Gender:*

MaleFemale
Race or Ethnicity:*
Please select race or ethnicity with which you most identify
Veteran:*

YesNo
Do you already have a class schedule?*

YesNo
Student Classification:*
Credits Earned: Transfer- 30+, Freshman- 0-29, Sophomore- 30-59, Junior- 60-89, Senior- 90+
Are you in Achievement in Mind (AIM) or Crossroads?*

NoOther
Major (UG)*
What Associate's or Bachelor's degree are you going to study for at Nelson University?
Major (GR)*
First semester at Nelson University:*
Semester you took (or will take) your first class at Nelson University (i.e., SPRING 2022, FALL 2022)
Student Type:*
OC- On Campus: All classes are in a physical classroom; DE- Distance Education: All classes are online; Hybrid- OC & DE: Mix of On Campus and Distance Education; SOM- Offsite School of Ministry
DE Type:*
OC Type:*
Residential- live at the campus Commuter- drive to the campus Extension Site- attend physical class at church
Hybrid Type:*
Online- entire class is online On-Campus- class is attended at Main or AIC campus On-Site- class attended physically somewhere else
Have you attended any other colleges or universities?*

YesNo
List other places you have studied.*
How many college credits (hrs.) have you currently earned?*
Diagnosed disability or injury #1*
How long have you experienced this?*
Disability/Injury #1
Add a 2nd disability

YesNo
Diagnosed disability or injury #2
How long have you experienced this?
Disability/Injury #2
Add a 3rd disability

YesNo
Diagnosed disability or injury #3
How long have you experienced this?
Disability/Injury #3
Add a 4th disability

YesNo
Diagnosed disability or injury #4
How long have you experienced this?
Disability/Injury #4
Add a 5th disability

YesNo
Diagnosed disability or injury #5
How long have you experienced this?
Disability/Injury #5
Has a 504/IEP ever been provided?*
How does you disability/injury impact you as a student?*

Test-takingClassroom environmentDue datesPhysical accessNote-taking/LecturesAttendanceHousing/Dining servicesChapelOther
List other ways your disability/injury impacts you as a student.*
Use this space if you checked "Other" in the last question.
What kind of content is more challenging?*

MathReadingScienceWritingDigitalOnline coursesOn-campus classesLectures/PresentationsOther
What kind of accommodations are you requesting from Nelson University?*

TestingIn-classOnlineHearing/VisualAlternate format of textHousingDiningOther
Which devices do you use as a student?*

Smart phoneTablet/iPadLaptopOther
Do you use any technology to address the challenges of your disability?*

YesNo
Select any adaptive technology that has been helpful.*

Screen readerAudio booksAudio recording appsVoice-to-textOther
What are your academic and personal strengths?*
List specific personality traits and academic skills (e.g., studying, planning)
What are your academic and personal weakness?*
List specific personality traits and academic skills (e.g., studying, planning)
Professional Documentation

For most, this is the paperwork from your school district regarding your disabilities and accommodations. Examples: IEP Packets, 504 Committee Reports, ARD Meeting Reports, Physician's Letter, Therapist Letter, ETC.)
Follow this link to access the Guidelines for Disability Documentation
Attach professional disability documentation here:

Browse Files
Documentation can also be sent via email, fax, or mail using the contact information at the top of this form. Cancelof
Professional Disability Documentation can also be submitted by...

- Email: academicaccommodations@nelson.edu;

- Fax: 972-923-8188

- In-Person: Learning Centers located in the Davis Building
Click Save and Submit buttons below.
Should be Empty:

Professional Documentation