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Student Accommodation Request
Please fill out the following information prior to your intake meeting with the Disability Resource Center
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indicates a required field
Student Information
Please enter your information
Student ID
Required
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First Name
Required
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Last Name
Required
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Preferred Name
Email
Required
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Please use your university issued email address
Phone Number
Required
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Affiliations
Educational Opportunity Program (EOP)
Student Athlete
Transfer Student
Veteran/Military Service Member/Dependent of Military Service Member
Are you registered with ACCES-VR?
Are you registered with ACCES-VR?
Yes
Are you registered with ACCES-VR?
No
Do you receive services from Commission for the Blind
Do you receive services from Commission for the Blind
Yes
Do you receive services from Commission for the Blind
No
Will you be living on campus?
Required
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Will you be living on campus?
Yes
Will you be living on campus?
No
Are you interested in learning about campus involvement opportunities
Are you interested in learning about campus involvement opportunities
Yes
Are you interested in learning about campus involvement opportunities
No
Are you registered to vote?
Are you registered to vote?
Yes
Are you registered to vote?
No
Would you like to complete your voter registration with the DRC?
Would you like to complete your voter registration with the DRC?
Yes
Would you like to complete your voter registration with the DRC?
No
Disability Information
Documented Disability
Please pick all documented disabilities that apply
Upload supporting disability documentation
If you would like to submit your documentation online, please upload here.
Specific Accommodation Information
Briefly list the academic accommodations (if any) you have received in the past. NOTE: Please be brief as Accommodate has a character limit within this box and may cut off your response).
Required
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Briefly list the academic accommodations for your courses at New Paltz that you would like to discuss during your intake meeting. NOTE: Please be brief as Accommodate has a character limit within this box and may cut off your response).
Required
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Which categories from this list do you find are the most challenging for you.
Multiple choice exams
Essay/Writing
Finishing exams on time
Course Attendance
Group Projects
Reading Comprehension
Research Projects
Time-Management/Organization
Adequate Housing (During breaks, between semesters, etc).
Social Interactions
Listening/Focus
Note-taking
Short-term Memory
Agreement Statement
Agreement Statement
Required
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By typing my first and last name here:
I understand that the DRC has my permission to share my accommodation information with other SUNY New Paltz departments and faculty members for the purpose of helping me to succeed.
I recognize that it is my responsibility to submit a semester request in the beginning of each semester.
Document Information
Document Title
File
Required
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Maximum file size: 10240kb
Description