Request for Accommodations Form

Introduction

Princeton University is committed to providing students with disabilities equal access to its educational opportunities and programs. Princeton’s Policy on Disability and Accessibility is implemented in the context of the Americans with Disabilities Act (ADA) of 1990 as amended, Section 504 of the Rehabilitation Act of 1973 (Section 504), and the New Jersey Law Against Discrimination, which prohibit discrimination on the basis of disability. The term “disability” may include learning, physical, sensory, psychological, medical, and certain temporary disabilities. The University provides students with reasonable accommodations in accordance with the ADA/Section 504 and applicable state law. Students with disabilities may request academic accommodations; housing and dining accommodations; modifications to University policies, rules, and regulations; environmental adjustments such as the removal of architectural, communication, or transportation barriers; and auxiliary aids and services. For information on services and requirements, visit the ODS website at http://ods.princeton.edu/.

First Name

Middle Name

Last Name

Legal Name (if different)

PU ID (9 digits)

Email

Please use your university issued email address

Preferred Phone Number

Address

Class Year

Residential College or Graduate School

Enrollment Status (Choose all that apply)

Disability Information

Type of Disability

Specify your diagnosis or diagnoses and provide the date of original diagnosis

Provide history of disability and background information, including prior treatment and any prior special supports.

Functional Impact

How does your disability impact your ability to complete coursework or other program requirements?

How does your disability impact your daily activities outside the classroom?

Treatments and Supports

Do you take any medication related to your disability?

Do you use any special equipment, assistive technology, mobility aids or auxiliary aids?

Prior Academic Accommodations

Were you approved for accommodations in a prior academic setting?

Were you approved for accommodations for the SAT?

Were you approved for accommodations for the ACT?

Were you approved for accommodations for the GRE?

Were you approved for accommodations for the other standardized testing?

Current Accommodation Requests

Please explain below the category of accommodation request, the nature of the accommodation request and your rationale for the need for each accommodation that you wish to request. After entering your first request, you will be prompted to provide the same information for each additional request.

Select the accommodation category for your first request.

Identify your first accommodation request

Explain the rationale for your requested accommodation.

Do you have additional accommodation requests?

Temporary Accommodation Requests

Are your accommodation requests temporary?

Please note if you are already registered with the Office of Disability Services, you must make a temporary accommodation request in Accommodate through the Supplemental Accommodation Request.

Referrals

Were you referred to ODS by a PU staff or faculty member?

Documentation

Upload supporting document(s)

All accommodation requests must be supported by appropriate documentation completed by a qualified professional.

For documentation requirements, please contact ODS or visit: https://ods.princeton.edu/student-services/documentation-requirements

Accommodation requests cannot be considered until appropriate documentation is received by ODS.

Certification and Permission

Under the Family Educational Rights and Privacy Act (FERPA), the Office of Disability Services (ODS) may share information and communicate with appropriate University personnel on a need-to-know basis in order to facilitate the process of determining accommodation eligibility and/or implementation. In addition, the Office of Disability Services’ evaluation may include review of your documentation by an external consultant engaged by the University. In limited circumstances, specific information may be required to be disclosed in order to protect individuals in an emergency or to comply with law and/or University policies and procedures. The information on this form may be used in aggregate form for reporting purposes.

Permission Agreement

I give permission for the Office of Disability Services staff and/or University professionals assisting ODS to speak with or request information from the treating professional who provided or will provide documentation (if not attached) to support my accommodation request(s) if needed to make an accommodation decision. I understand that this authorization is voluntary

I understand the Office of Disability Services is not a “confidential resource” (as defined in the University’s Sexual Misconduct Policy) and may be required to report to appropriate University personnel situations in which a student expresses intent to harm self or others, and where a student discloses sexual harassment, assault or related violence.

I understand that my accommodation request(s) cannot be considered until appropriate documentation is submitted. I understand Princeton’s use of the information on this form as stated above. If I responded affirmatively above, I am giving permission for my treating professional to be contacted, if necessary, to determine accommodation eligibility. I understand that ODS is not a confidential resource.

Please prove you are not a robot

By clicking submit, I acknowledge that I am the individual stated in the application and the information provided is true, accurate and complete.