Application to Initiate Services

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Student Information

Please use your university issued email address
Can we leave a message at this number?
Is finding the time to study difficult?
Is reading comprehension difficult for you?
Is writing difficult?
Is math difficult?
Do you have trouble taking tests?
Do time limits bother you?
Have you ever been to tutoring?
Are you taking any medications?
Drop files here to upload

Release of Information

I have truthfully completed the information contained in this application to the best of my ability. I understand this information will be used as part of an assessment of my intellectual, psychological, and physical abilities. I understand that having this assessment will not guarantee an accommodation or result in a diagnosis of a disability. I understand that I must request specific accommodation(s) for each of my classes and supply DSS with information about my classes and professors each semester. Accommodations will be determined by the Disability Services Accommodation Committee after consideration of documentation and my individual needs. I authorize the personnel of DSS to disclose appropriate information with those on and off campus that have a legitimate safety and educational need to know. I also authorize those individuals to relate to DSS my progress through their services. I realize and agree that for possible future research, the information collected in my file may be included in group data. Such data will be coded in a manner that does not identify me personally.
  
Format as: two digits for month, dash, two digits for day, dash, four digits for year (yyyy-mm-dd)

Informed Consent

Informed Consent for Disability Support Services

Confidentiality
The Disability Support Services (DSS) staff adhere to laws and ethical standards that require applicable information to be held in confidence. Such information can be released to others outside DSS only when an educational, health or safety issue creates a need to know. Exceptions to these requirements arise in those circumstances in which DSS staff are required by law to report suspicion of child, domestic, mentally ill, disabled, or elder abuse or in which the client presents a serious danger to him/herself or others.

Your Responsibility
In order to receive accommodations, you must first voluntarily provide appropriate, up-to-date documentation, sign an informed consent form, and request specific accommodations based on your documentation. Only requests deemed appropriate and reasonable will be recommended to instructors.
Once the Accommodations Data Sheets are ready for your signature, you need to hand-deliver them to your professor(s) and negotiate as to how the accommodations will be provided.
In order to continue receiving accommodations, you must submit an updated request for accommodations.

Eligibility
Your eligibility for service is contingent upon your status as a registered or continuing Southern Adventist University student. The services you receive are based upon a determination of your needs and goals. If DSS is unable to meet your needs, you will be given a referral to resources that may be able to help you.

Records
A confidential record of services provided and your progress through those services is maintained with access generally limited to DSS and Counseling & Testing (C&T) staff (for additional access information, see “Confidentiality” above).

Appointments
DSS support services are free of charge for eligible students.
Making appointments, both for meeting with personnel and for using equipment, is recommended, but if none has been made, you can access staff and equipment without appointment, pending availability.

If staff cannot keep an appointment with you, a good-faith effort will be made to notify you. (To facilitate such notification, please make sure you have accurately listed your contact information on “My Access.”)

Grievance Procedure
Students with questions, concerns, or complaints regarding disability accommodations or services are encouraged to first contact the Disability Services Coordinator at ext. 2574 or visit Suite 3900 in the Beitz Center to seek an informal resolution.

To initiate a formal grievance procedure, students may obtain the appropriate grievance forms from either Disability Support Services (DSS) or Counseling and Testing, located in the Beitz Center, Suite 3800. Completed grievance forms should be submitted to the Director of Student Support Services for review and follow-up.

  
Format as: two digits for month, dash, two digits for day, dash, four digits for year (yyyy-mm-dd)