Accommodation Request Form

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Student Information

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Specific Accommodation Information

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Disability records are kept separate from academic, disciplinary and medical records to ensure each student’s privacy and confidentiality. No information is released without the knowledge and written consent of the student, except for those rare instances where disability services is required by law to reveal particular information.

In compliance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) of 1990, the University will not discriminate against or deny access to otherwise qualified students with disabilities. A reasonable accommodation is a modification or adjustment to a program, course or activity to enable an otherwise qualified student with a disability to participate in academic and activity programs at Carroll University. The University is obligated to provide reasonable accommodations only to the known, recognized limitations of an otherwise qualified student with a disability. Otherwise qualified students with disabilities who seek accommodation(s) must complete this form before requested, reasonable accommodation(s) can be reviewed and/or provided. If necessary, the student may be requested to provide additional documentation of his/her disability. If the University requires a second opinion, the student will be asked to undergo an independent medical exam (IME). The cost of the IME will be borne by the University. Failure by the student to provide necessary information or to undergo the IME can result in the denial of accommodation(s).

I understand that the provision of reasonable accommodation can occur only after the University has received a proper request from me, accompanied by all necessary documentation to support the need for accommodation. I also understand that receipt of reasonable accommodation(s) will occur only if I remain an otherwise qualified student at the University and if the requested accommodation(s) do not alter the fundamental nature of the course, program or activity in which I am enrolled, or pose a threat to the health and safety of others.

Please note: to determine reasonable accommodation(s), the Disability Services Director may seek information from appropriate University personnel regarding the academic and technical standards for affected programs, courses and activities.