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Student Accommodation Request
Please fill out the following information prior to your intake meeting with the Disability Resource Center
*
indicates a required field
Student Information
Please enter your information
Student ID
Required
*
First Name
Required
*
Last Name
Required
*
Preferred Name
Email
Required
*
Please use your university issued email address
Phone Number
Required
*
Affiliations
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
Will you be living on campus?
Required
*
Will you be living on campus?
Yes
Will you be living on campus?
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
What academic accommodations have you received in the past?
Required
*
What academic accommodations are you requesting at New Paltz?
Required
*
Courses Most Challenging
Multiple choice exams
Essay/Writing
Finishing exams on time
Course Attendance
Group Projects
Reading Comprehension
Research
Time-Management/Organization
Housing
Social Interactions
Listening/Focus
Note-taking
Short-term Memory
Release of Information
Release of Information
Please list the name(s) of any individual(s) (and their relationship to you) that you would like the DRC to have permission to speak to on your behalf.
Agreement Statement
Agreement Statement
Required
*
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
Required
*
File
Required
*
Maximum file size: 10240kb
Description