Accommodation Request Form for Students with Disabilities

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Accommodations at Quinnipiac

Quinnipiac University is committed to providing equal educational opportunities and full participation for students with disabilities. Consistent with its responsibilities to comply with the Americans with Disabilities Act of 1990 (ADA) and Section 504 of the Rehabilitation Act of 1973, Quinnipiac University provides reasonable accommodations to promote equal educational opportunity. Documentation from a licensed evaluator is required to substantiate the presence of a disability, defined by the ADA as “a physical or mental impairment that substantially limits one or more major life activities,” and to establish the need for reasonable accommodations at Quinnipiac University.

Housing Accommodation Request Deadlines

Completed form and documentation must be received by the respective deadlines below to be considered for housing accommodations. Forms submitted after these dates will be reviewed, but accommodations will be met based on housing capacity. All other accommodation requests can be submitted at any time and will be reviewed in a timely fashion.

  • November 1 - Current Juniors
  • March 1 - Current First-Year Students/Sophomores
  • May 26 - Incoming First-Year Students/Transfer Students
Please use your university issued email address.
Current status
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Type of accommodation being requested
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Upload supporting document(s)

Guidelines for Medical Accommodations

Documentation must be dated and signed with the appropriate credentials by the providing professional.

  • •A diagnostic statement identifying the disability from a licensed/certified professional: The diagnosis should include a description of diagnostic methods, including the DSM-5 diagnosis if applicable, and criteria utilized along with the date of evaluation. The licensed professional providing the diagnosis cannot be a family member.
  • •Current functional impact of the condition: Describe the current relevant functional impact of the disability in an educational setting.
  • •The expected progression of the disability over time: Provide a description of the expected change in the functional impact of the condition over time. If the condition is variable, describe the known factors that may exacerbate the condition.
  • •Treatment: List treatments, medications, accommodations/auxiliary aids and/or services currently in use and their estimated effectiveness in addressing the impact of the condition. Include any significant side effects that may affect physical, perceptual, behavioral or cognitive performance.
  • •Supporting documents: You are encouraged to submit any past documentation or materials that establish a history of receiving appropriate accommodation in a previous academic setting when available. Secondary school accommodation plan such as IEPs or 504 Plans are helpful, but often do not provide sufficient information to establish eligibility for the requested accommodations at the university level when submitted without a corresponding evaluation.

Consent for Release of Information

In connection with the services you are using at the Office of Student Accessibility, it may be necessary for us to obtain additional information about you from your physicians and/or counselors, prior schools, other institutions and agencies. We may also want to discuss directly with them verbally and/or in writing the information we obtain or any questions we may have that we feel might help you while you are at Quinnipiac University. In addition, while we are ever mindful that your grade transcripts, medical records and other personal information are confidential, it may be necessary for us to discuss the information and records we have about you with others at the University who could help you by knowing your access requirements for example: your professors and counselors.

Accordingly, by signing below you are indicating your agreement with the above and your authorization for the Office of Student Accessibility staff and/or their designees to follow through with that agreement. You are also limiting Office of Student Accessibility staff or their designees’ right to disseminate said information for the sole purpose of helping you with your accommodation needs and limit any medical information only to the medical history that would relate to your access requirements expressly not authorizing the release of any medical records or information not related to your access requirements.

This authorization shall expire when you have officially withdrawn or graduated from Quinnipiac University.

  
Is there anyone you would like to give permission to discuss your case with us?