Student Accommodation Request

Student Information

Please enter your information

Student IDRequired *

First NameRequired *

Last NameRequired *

Preferred Name

EmailRequired *

Please use your university issued email address

Phone NumberRequired *

Affiliations

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 *

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 *

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 *

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

Are you interested in additional Autism Support Services?

https://www.newpaltz.edu/drc/asdservices.html

Are you interested in additional Autism Support Services? Yes Are you interested in additional Autism Support Services? No

Campus Life: Will you be living on campus?

Campus Life: Will you be living on campus? Yes Campus Life: Will you be living on campus? No

Campus Life: Name of Residence Hall (if known)

Campus Life: Have you communicated with your roommate(s) yet?

Campus Life: Have you communicated with your roommate(s) yet? Yes Campus Life: Have you communicated with your roommate(s) yet? No

What supports would be beneficial in successfully transitioning to living in the residence hall?

Educational Information

Are you interested in a weekly group to increase skills related to independent living?

How were your classes structures in high school?

i.e. small groups, regular classes, advanced placement, etc.

What comes easily for you academically?

What challenges you academically?

Did you receive any support services or accommodations in high school?

Will you be requesting academic accommodations at SUNY New Paltz?

Will you be requesting academic accommodations at SUNY New Paltz? Yes Will you be requesting academic accommodations at SUNY New Paltz? No

Are you entering as a freshman? If no- state classification.

If you are a transfer student- what previous college did you attend?

Have you declared a major at SUNY New Paltz? If Yes, what major?

Does your ASD impact your academic success? If yes, how?

i.e reading, writing, concentration, time-management, communication, etc.

Relationships

Describe your relationships with other people

Friends

Teachers

Family

Do you experience social challenges? If YES- describe 1-2 common challenges

What situations most commonly trigger your stress response?

How do you cope when you get frustrated/ anxious?

How do you relax/ recharge?

Transition to SUNY New Paltz

What have you done to prepare for your transition to SUNY New Paltz?

What are you most looking forward to about your transition to SUNY New Paltz?

What are you most worried about as you transition to SUNY New Paltz?

Would you like to register for the 1 credit DRC course "Transition to College"?

Would you like to register for the 1 credit DRC course "Transition to College"? Yes Would you like to register for the 1 credit DRC course "Transition to College"? No

Would you like to be matched with a peer mentor?

Would you like to be matched with a peer mentor? Yes Would you like to be matched with a peer mentor? No

ASD Supports

What skills would you like to improve upon with the Compass Program?

What supports within the Compass Program would be beneficial?

Supporter Information

Supporter Name (first and last) & relationship to you

Supporter Email

Supporter Cell Phone Number

Do you currently receive support from a therapist or other mental health/ medical professional?

Do you currently receive support from a therapist or other mental health/ medical professional? Yes Do you currently receive support from a therapist or other mental health/ medical professional? No

Do you plan to continue working with them while you are attending SUNY New Paltz?

Do you plan to continue working with them while you are attending SUNY New Paltz? Yes Do you plan to continue working with them while you are attending SUNY New Paltz? No

Agreement Statement

Agreement StatementRequired *

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.

Please save and complete the FERPA form to provide permission for your supporter to speak to DRC. Upload to Accommodate.

https://www.newpaltz.edu/media/ferpa/auth-to-release.pdf

Student Accommodation Request

Student Information

Disability Information

Specific Accommodation Information

Agreement Statement

Document Information