Application for Accommodations

The Application for Accommodations and Services Request Form allows students with disabilities to request reasonable accommodations to ensure access to programs and activities. These accommodations may include academic adjustments, auxiliary aids, or facility changes.

Process to Receive Accommodations:

Complete the application.
Submit documentation verifying functional limitations due to the disability.
Your application and documentation will be reviewed.
You will be notified of approved accommodations via your Sussex email, unless a face-to-face meeting is needed.

Documentation Guidelines:

Provide official documentation of your disability to [email protected].

Learning Disability: Recent psycho-educational or psychological report and IEP, LOA, or 504 Plan (within three years).
Attention Deficit Disorder: Diagnosis from a physician or clinical psychologist, with supporting test results sent to us.
Psychological Disability: Recent psychological evaluation with diagnosis and recommended accommodations.
Physical Disability/Chronic Medical Condition: Medical documentation of disability and limitations.
Hearing Impairment: Latest audiogram (within two years) and details on limitations/accommodations.
Visual Impairment: Recent eye exam results.
Other Disabilities: A letter from your physician verifying the disability, including diagnosis, onset date, prognosis, and needed accommodations.

Timely submissions (within 2 weeks) are encouraged for effective planning. For assistance, contact Lauren Windrow at [email protected] or 973-300-2153.

Application for Accommodations

Student Information

First Name

Last Name

Student ID#

51吃瓜 Email Address

Phone Number

Reason for Request

Initial Request for accommodations

Requesting adjustments to approved accommodations

Disability Information

Please provide a list of disabilities for which you have received a professional diagnosis:

Documentation Agreement

I acknowledge my responsibility to submit my supporting documentation.

I have questions about obtaining my documentation and acknowledge my Accommodation Letter will not be written until my supporting documentation has been received.

Privacy: Information provided to the Accessibility Service Office is considered confidential. Under the Family Educational Rights Privacy Act (FERPA), all information derived from communication with you or through your educational records will be held in strict confidence unless released by you.