Application for Accessibility Services

Registering with the Office of Accessibility Services Franklin University is committed to ensuring that all students have equal access to its academic programs. We are dedicated to serving the needs of students whose disabilities may provide functional limitations in the academic setting and to provide reasonable accommodations. Students are entitled access to all University programs if “otherwise qualified” to participate. They are obligated to provide notice of the nature of the disabling condition to the University. To do this you must register with the Office of Accessibility Services Coordinator.

Registration The Office of Accessibility Services (OAS) is responsible for coordinating and ensuring equal access for students to courses, programs, services, and activities offered by the University. You may register with the OAS as a new student, a current student, or if you were just diagnosed with a disability or impairment.
Requests for accommodations or services may be made at any time; however, keep in mind that some accommodations may take time to arrange. Be aware that accommodations are not retroactive and cannot be made for events or exams that have occurred prior to the request. To register:

1. Complete the Accessibility Services Application.
2. Schedule an appointment, in person or by telephone, with the Accessibility Services Coordinator for an intake accommodation assessment.

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Definition of a Disability A person has a disability if he or she has a physical or mental impairment that substantially limits one or more “major life activities.” Major life activities include functions such as walking, seeing, hearing, breathing, learning, working, caring for oneself, and performing manual tasks.

Diagnosis by a Qualified Professional Students requesting services must provide information of their disability from a qualified professional. A “qualified professional” has significant experience diagnosing and/or treating a given disorder. The information should provide a specific description of how the disability interferes with educational achievement.

Confidentiality Statement Disability information is shared only on a limited basis within the University and only when there is compelling need to communicate with faculty and staff in order to achieve implementation of reasonable accommodations.

Self-identification of a Disability To be eligible for accommodations, you must self-identify as a person with a disability or impairment to the Office of Accessibility Services. Disclosure of this information is voluntary, and no adverse consequences will result from providing this information.

Disability/Impairment Type with Documentation Guidelines If the information provided is incomplete or inadequate, you may be required to provide additional documentation. You are responsible for any costs associated with obtaining documentation.

Accommodations are determined on a case-by-case basis, depending on the nature of the disability and the information provided.

Accessibility Services Application and Medical Verification

Please complete the following form to the best of your ability. If you have questions about completing this form, please contact the Office of Accessibility Services at accommodate@franklin.edu.

* indicates a required field

Student Information

First Name*

Last Name*

Franklin Student ID

Email Address

Enrolled Term

Academic Information

Have you previously received services?

Yes

No

If Yes, please describe services:

Disability Information

Identify all that apply and for which you are submitting official documentation from a qualified professional:*

If Other, please list:*

Explain how your disability affects you in an educational setting:*

Verification of Psychological Condition and/or Chronic Medical Condition

The Office of Accessibility Services at Franklin University provides services and/or accommodations for students with documented disabilities to facilitate equal access to educational opportunities. To determine eligibility for accommodations, current and comprehensive information regarding a physical or psychological condition and its impact on the students functioning is required from someone who is qualified to diagnose and treat the particular condition(s).

Diagnosis:*

Date of Diagnosis:

Is this a Temporary or Permanent Condition?

Temporary

Permanent

How might this condition substantially limit the student’s functioning in a university academic setting (e.g., unable to concentrate or sit for long periods of time, walk certain distances, etc.)?

Statement of Responsibility

I will be notified of any approved accommodations within one week of receipt of all documentation. Any requests for additional accommodations during the semester may be delayed because of the resources that need to be pulled to meet the request (ex: alternative format textbooks, note taker, etc.)*

I UNDERSTAND

It is my responsibility to contact the Office of Accessibility Services every term to discuss my class schedule and accommodations needed.*

I UNDERSTAND

It is my responsibility to contact the Office of Accessibility Services if I ADD or DROP any classes from my schedule.*

I UNDERSTAND

It is my responsibility to notify the Office of Accessibility Services if I am having problems with the accommodations that have been provided.*

I UNDERSTAND

I certify that I have completed this form accurately and to the best of my ability.

Application for Accessibility Services

I AM A:

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