Disclosure of Disability Form

91精品 is committed to providing all students with optimum learning experiences. This commitment applies to students who have special needs due to a disability.

If you have a disability and will need accommodations while attending an 91精品 campus, please complete this form.

Student's First Name*

Student's Last Name*

91精品 Student ID Number*

Campus*

Email Address*

Mailing Address

City

State

Zip Code

Preferred Phone Number*

Will you require accommodations each semester?

Yes

What is the nature of your disability?*

Please describe how your disability impacts your academic success.*

Please describe effective accommodations that you have received during your educational career.*

Accommodations will be implemented after the student’s needs are determined. Please provide documentation from an external source. This may include educational or medical records, reports, and assessments created by healthcare providers, school psychologists, teachers, or the educational system. This information is inclusive of documents that reflect education and accommodation history, such as Individual Education Program (IEP), Summary of Performance (SOP), and teacher observations. External documentation will vary in its relevance and value depending on the original context, credentials of the evaluator, the level of detail provided, and the comprehensiveness of the narrative. Disability documentation should be current or relevant but not necessarily “recent.”

Email documentation to disabilityservices@91精品niv.edu.

After you have submitted your form and documentation, the Accessibility Coordinator will contact you to discuss your needs.

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Disclosure of Disability Form

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