Boston University ODS Initial Request for Accommodations

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Student Information

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Disability & Access Services (DAS) arranges academic accommodations for qualified students with disabilities. Such accommodations may include use of a laptop for notes, a smart pen, laboratory assistance, course materials in alternative formats, reduced course load, or possibly examination-related accommodations such as extended time or a distraction-reduced environment. Students seeking accommodations will need to fill out this form and schedule an intake appointment to meet with one of the DAS staff members.

PLEASE NOTE: The process can take up to three (3) weeks once all documentation has been submitted.

First Name(Required) *

Last Name(Required) *

Preferred Pronouns

Preferred Pronouns He, Him, His
Preferred Pronouns She, Her, Hers
Preferred Pronouns They, Them, Their, Theirs
Preferred Pronouns If other, please indicate below

Other Preferred Pronouns

If you have preferred pronouns other than those listed above, please indicate them here.

Student ID(Required) *

Please include all 9 characters including the "U", without dashes

Phone Number(Required) *

Email(Required) *

Please use your university issued email address

Please select college or program

If you chose "other" above please specify here

Major or Concentration

What school are you visiting from?(Required) *

Are you studying abroad?(Required) *

Are you studying abroad? Yes Are you studying abroad? No

Tell Us About Yourself

How were you referred to Disability & Access Services?

Check all that apply

Advising Offices
Career Services
Dean of Students
Family
Friend
Judicial Affairs
Medical Doctor
Professor
Residence Life
SARP
Self
Student Health Services
USC (University Services Center)
Other (please explain below)

Briefly describe why you are contacting disability services.(Required) *

Tell us why you are reaching out?

Are you seeking housing accommodations?(Required) *

Are you seeking housing accommodations? Yes Are you seeking housing accommodations? No

Briefly describe accommodations you are seeking from Housing:(Required) *

Please note that DAS can advise the Housing office regarding your accommodation request. We are not in charge of the Housing process.

Disability Category (check all that apply)

ADD/ADHD
Allergy
Asperger's/Autism
Deaf/Hard of Hearing
Learning disability
Medical condition
Mobility impairment
Neurological condition
Psychological impairment
Temporary injury
Traumatic brain injury/concussion
Visual impairment
Unsure

What is your formal diagnosis?

Please describe your disability and how it currently affects you(Required) *

Are you Deaf or Hard of Hearing?

Are you Deaf or Hard of Hearing? Yes Are you Deaf or Hard of Hearing? No

How do you identify?

Please check all that apply

Deaf
Deaf-Blind
Hard of Hearing
Late-Deafened
Oral Deaf
Other

Please Describe

What services are you requesting?

ASL interpreter
CART - Onsite
CART- Remote
CDI [Certified Deaf Interpreter]
Deaf-Blind -Tactile
Oral Transliterator
PSE/Sign Language Transliterator
VRI- Video Remote Interpreter

Have you ever received accommodations from another school?

Have you ever received accommodations from another school? Yes Have you ever received accommodations from another school? No

What accommodations were you approved for, and by which institution(s)?

Are you currently in therapy?

Are you currently in therapy? Yes Are you currently in therapy? No

How often do you go?

Provider name

Have you been in therapy in the past?

Have you been in therapy in the past? Yes Have you been in therapy in the past? No

Are you currently taking any medications?

Are you currently taking any medications? Yes Are you currently taking any medications? No

Current Medications (please describe)

Have you ever received accommodations for standardized testing?

Have you ever received accommodations for standardized testing? Yes Have you ever received accommodations for standardized testing? No

What accommodations were you approved for, and for what standardized test(s)?

When was the most recent evaluation of your condition and who conducted the evaluation?

Documentation

To see Boston University documentation guidelines - please click below:

BU Documentation Guidelines

Upload supporting document(s)

Academic Information

Describe how your disability currently impacts your academic life

In which courses are you usually most successful? Which give you more difficulty?

Which aspects of learning do you find the most challenging?

(i.e. Reading, paper writing, organization, note-taking)

Please list any Boston University resources you have utilized

(Ex. Educational Resource Center, Behavioral Medicine, CARD, SARP, Career Development Center)

Academic Accommodations Requested

Please list the accommodations that you feel are necessary to allow you to access our curriculum and community(Required) *

Please describe how each accommodation relates to your disability

Do you or have you used any adaptive technology or devices? If so, please describe what has been the most helpful

Other Information

Do you currently live in BU housing?

Do you currently live in BU housing? Yes Do you currently live in BU housing? No

Which dorm?

How many roommates do you have?

Are you a student athlete?

Are you a student athlete? Yes Are you a student athlete? No

Which sport(s)?

Do you use the Athlete Academic Support Center?

Do you use the Athlete Academic Support Center? Yes Do you use the Athlete Academic Support Center? No

Other Important information:

Please check all that apply:

I am an incoming student
I am a visiting student
I am a prospective student
I am returning from a leave of absence
I am on academic probation
I am an online student
I am an international student
I am a transfer student
I am or a member of my family is a BU employee
I am a client of vocational rehabilitation
I am an active service member or a veteran
I am involved with Judicial Affairs

Are you having any concerns regarding: (check all that apply)

Allergies
Anxiety
Drugs/Alcohol
Gender/Sexuality
Homesickness
Housing
Nutrition
Over/Under Sleeping
Relationships
Roomates
Socializing
Stress Management
Time Management/Organization
Workload

Please include anything else you would like Disability & Access Services to know in order to best assist you

Please list any questions you have about our services that we can answer for you

Policies and Procedures

Please Read(Required) *

Below are the general polices of the Disability & Access Services office at Boston University (DAS)
Please read and type your name in the box below.

I understand that:

→ It is my responsibility to provide accurate and timely documentation to DAS.

→ It is my responsibility to check my Accommodate Portal for updates and announcements.

→ Once my documentation is in and I have had a formal intake, the process can take up to three weeks to be completed.

→ It is my responsibility to request accommodations each semester.

→ I must notify DAS if I drop or add classes.

→ It is my responsibility to print and deliver my accommodation letters to my professor in a timely fashion.

→ If I am requesting a new accommodation, I must provide updated documentation and meet with a staff member

→ It is my responsibility to communicate directly with my faculty regarding exam accommodations, and stay in communication about the time and place of such exams.

→ It is my responsibility to contact Disability & Access Services in a timely fashion if I am having any difficulties in securing or arranging accommodations.

→ I am responsible for the condition and timely return of any equipment I use or borrow from DAS.

→ If I am approved for Notetaking or Audio recording services, I understand that the notes and/or recordings are for my use only and may not be shared. In addition, I understand that I will only receive these services when I am present.

→ Requesting accommodations does not mean I have been or will be approved.

→ Some accommodations may be approved temporarily. This may be due to insufficient documentation and/or type of disability. In these cases, I will need to update my documentation to receive accommodations again.

→ DAS does not provide retroactive accommodations.

→ Faculty are not required to provide any accommodation that fundamentally alters the nature of their course or lowers their academic standards.

→ Faculty are not required to provide any accommodation without receiving a paper copy of your Faculty Accommodation Letter at least one week in advance of a quiz or exam.

→ It is my responsibility to ask the professor of record whether other professors or academic personnel (such as course coordinators or teaching fellows) need to be informed of my approved for accommodations. It is also my responsibility to inform those professors as well.

→ Failure on my part to carry out any of these responsibilities may result in my inability to secure accommodations.

Adding your name below indicates that you have read, understood and agreed to the policies of DAS.

Thank you for completing this form. If you haven't yet, please contact us at 617-353-3658 to schedule an intake appointment.

For students who are Deaf or Hard of Hearing, please email us at aslods@bu.edu.

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