Please enter your information below. Supporting documentation MUST be attached to the application at the time of submission. You will be prevented from submitting this request without the attached documentation.
Documentation verifies your eligibility for accommodations under Section 504 of the Rehabilitation Act, the Americans with Disabilities Act, and the ADA Amendments Act. Documentation commonly submitted includes, but is not limited to, IEPs and/or letters from treating physician/clinician. All documentation submitted is considered confidential.
Documentation must be in .pdf or .doc file format.
In the event that you may not have access to a scanner or fax, you can utilize a free app that converts images into pdf files (eg., CamScanner).
The specific type of academic accommodation(s) you are requesting will be addressed below.
The specific type of housing accommodation(s) you are requesting will be addressed below.
I authorize the Office of Accessible Services Individualized for Students and Residence Life and Housing to share information from my records with others as deemed appropriate.
Types of temporary accommodation(s) are parking requests and having a car on campus, for example.
In order to provide students with appropriate accommodations, documentation is beneficial in determining eligibility and accommodations. Documentation provides a valuable tool in the collaborative process of providing access to the educational process. Documentation should:
1. Clearly state the condition that meets the criteria for a disability under the law based on the current diagnostic standards.
2. Describe the current impact resulting from the disability or disabilities. Please consider expected changes in the impact of the condition(s) over time and in a different environment.
3. Clearly state the length of time the temporary disabling condition may require the requested accommodation(s).
4. Include educational, developmental, and medical history relevant to the disability for which accommodations and services are being requested.
5. Provide the reason (temporary educational or environmental accommodation requests) for submitting the documentation.
6. Include the professional's name, title (including licenses and credentials that indicate the qualification to describe and diagnose disability), date of evaluation, and report typed with signature.
I understand that to be eligible for accommodations at East Stroudsburg University I must provide this completed form and participate in an intake interview with a disabilities specialist. I also understand that submitting supporting documentation will assist the Office of Accessible Services Individualized for Students in providing me with appropriate accommodations. I authorize the Office of Accessible Services Individualized for Students faculty to share information from my records with other staff members in the Office of Accessible Services Individualized for Students and pertinent university departments as necessary until I sign the Release of Information Form during my intake interview.
Please submit documentation as either a .pdf or .doc file. No other types of file formats will be accepted. In the event that you may not have access to a scanner or fax, you can utilize a free app that converts images into pdf files (eg., CamScanner).