Office of Student Accommodations Application

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Student Information

Please enter your information

Notice

This form must be completed by the student requesting accommodations. Parents, guardians, and others should not submit this form on the student’s behalf, as the student is required to acknowledge and consent to the statements at the end of the form prior to submission.

Within 1 business day of submitting this form, you will receive an email to your WVU MIX address with the name and email address of your Accommodation Specialist and a link that you will use to schedule a phone call with your Specialist. This phone call must take place before academic or housing accommodations can be authorized.

Are you seeking academic accommodations?Required *

Are you seeking academic accommodations? Yes Are you seeking academic accommodations? No

Are you seeking housing accommodations?Required *

Are you seeking housing accommodations? Yes Are you seeking housing accommodations? No

Are you seeking transportation accommodations?Required *

Are you seeking transportation accommodations? Yes Are you seeking transportation accommodations? No

Select the semester when you want to start your servicesRequired *

Please select all that apply.

First NameRequired *

Last NameRequired *

Middle Name

Preferred Name

WVU Student ID NumberRequired *

If you do not know your WVU Student ID number (800 number), use the WVU Student ID Lookup. If you receive an error stating "Accessibility request exists for this student", please contact our office at 304-293-6700.

EmailRequired *

Please use your MIX email address.

Student Phone NumberRequired *

Additional Phone Number

Pronouns

Seeking Degree

Affiliation(s)

Which of these program are you currently participating in?

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Campus Location(s)Required *

{"display_name":"Campus Location(s)","hidden_field_name":"ms_field_2","init_id":"ms_field_2","init_link":"","has_autocomplete":false,"has_hierpicklist":null}

Specific Accommodation Information

Primary DisabilityRequired *

What is your current student status?Required *

What is your current student status? Current WVU Student
What is your current student status? Transfer Student
What is your current student status? Incoming Freshman
What is your current student status? Incoming Graduate/Professional Student

Documentation StandardsRequired *

Documentation standards can be found on our website at http://osa.wvu.edu/student-resources/forms. Please select what type of documentation you are providing

Documentation Standards Diagnostic Testing
Documentation Standards Letter from Doctor/Licensed Professional
Documentation Standards I am working to get a copy of my documentation

Additional Notes/Comments about documentation

Academic Accommodation Information

This section will appear if you have indicated you were requesting academic accommodations.

Have you ever had an IEP, Section 504 plan, or received accommodations in high school? Required *

An Individualized Education Plan (IEP), 504 Plan, outdated documentation, and evaluations normed on child scales may not provide sufficient documentation. A request for additional documentation, as well as further evaluation, may also be discussed to assist in the authorization of accommodations.

Have you ever had an IEP, Section 504 plan, or received accommodations in high school? Yes Have you ever had an IEP, Section 504 plan, or received accommodations in high school? No

What did you receive in high school? Required *

IEP
Section 504 Plan
Received Accommodations in High School
Not Sure

List accommodations you previously received in High School or at another institution.

Previous Accommodations Note/Comments

How does your condition/disability impact you academically? (i.e. reading, writing, concentration, memory, time management)Required *

What academic accommodations are you requesting?Required *

Housing Accommodation Information

This section will appear if you indicated you were requesting housing accommodations.

Do you have a current room assignment?

Do you have a current room assignment? Yes Do you have a current room assignment? No

If yes, please specify below

What kind of Housing Accommodations are you requesting?

Additional Housing Needs (Specify Below)
Air Conditioning
Elevator Access
Emotional Support Animal
Housing Exemption
No Carpet
Suite-style (Attached) Bathroom
Bed Shaker Alarm
Private Bedroom
Wheelchair Accessibility

Additional Note/Comment regarding Housing Accommodations

Transportation Accommodation Information

This section will appear if you indicated you were requesting transportation accommodations.

Is your need for transportation permanent or temporary?Required *

Is your need for transportation permanent or temporary? Temporary
Is your need for transportation permanent or temporary? Permanent

What is the start date for your transportation needs?

Where would you prefer to board the on-campus transportation shuttle?

Where would you prefer to board the on-campus transportation shuttle? University Housing (Specify Below)
Where would you prefer to board the on-campus transportation shuttle? Specified on-campus ADA pick up location (Specify Below)
Where would you prefer to board the on-campus transportation shuttle? Mountaineer Station (Parking pass required. Fees apply)
Where would you prefer to board the on-campus transportation shuttle? Transportation Services on the Mileground (Parking pass required. Fees apply)

In which university housing do you reside? Required *

In which designated location do you need ADA pickup?Required *

Additional Note/Comment regarding boarding the on-campus transportation shuttle

Transportation AgreementRequired *

I understand that I must complete a student schedule form at https://wvu.qualtrics.com/jfe/form/SV_8uoYs1ELjhmaAe2 and contact the Office of Accessibility Services at 304-293-6700 to schedule a phone appointment with an accessibility specialist. **It can take up to 24-48 hours to get you added to the Accessibility Van Schedule.

Yes

Additional Resources

Are you interested in Mindfit? Required *

Mindfit is a program for students with a Learning Disability, ADD/ADHD, Traumatic Brain Injury, and/or Autism Spectrum Disorder. Please Note: Mindfit is a fee for service program that requires a separate application. The application and additional information about the program can be found at http://mindfit.well.wvu.edu/.

Are you interested in Mindfit? Yes Are you interested in Mindfit? No

Are you interested in the Autism Support Program? Required *

WVU Autism Support Program (ASP) is a fee-for service program through the Office of Student Accommodations that is focused on supporting WVU students with autism spectrum disorder as they navigate college life. Please note: ASP is a fee-for service program that requires a separate application. The application and additional information about the program can be found at https://osa.wvu.edu/programs/asp.

Are you interested in the Autism Support Program? Yes Are you interested in the Autism Support Program? No

Are you interested in joining the Accessibility Student Advisory Group (ASAG)?

The WVU Accessibility Student Advisory Group (ASAG) offers input and new ideas by directly advising, influencing, and improving OSA programs and initiatives regarding Disability. Group members will work with WVU Office of Student Accommodations on student engagement and outreach projects. More information on ASAG can be found at https://osa.wvu.edu/programs/asag

Are you interested in joining the Accessibility Student Advisory Group (ASAG)? Yes Are you interested in joining the Accessibility Student Advisory Group (ASAG)? No

Please review and check each box indicating you agree with each statement. Required *

Students must participate in the accommodation process by requesting their specific accommodation needs to the Office of Student Accommodations, by submitting appropriate documentation that meets WVU Documentation criteria, by communicating with their Accommodations Specialist to determine if a reasonable and effective accommodation is appropriate, by evaluating the nature and requirements of each class, and by communicating to the Office of Student Accommodations any difficulties they may be having in obtaining an authorized accommodation. Reasonable accommodations are authorized under appropriate circumstances and on an individual basis.

Students must otherwise be qualified to meet the academic requirements of each class, major, or program of study in which they are enrolled. Essential functions, tasks, standards, and requirements of a class, major, or program cannot be removed or waived. Possible performance standards may be applicable within the areas of observation; communication; sensory and motor function; intellectual, conceptual, integrative, and quantitative abilities; behavioral and social requirements.

By clicking the submit button below, I understand and acknowledge the following:

By submitting this application, I understand that it is my duty as a student to follow all University and Office of Student Accommodation processes and procedures as they are written.
By submitting this application, I understand that the Office of Student Accommodations has permission to review and evaluate information and/or documentation related to my disability related accommodations.
By submitting this application, I understand that the Office of Student Accommodations will send me an email to schedule an appointment with an Accommodation Specialist and that I must schedule an appointment prior to the approval of any accommodations.
By submitting this application, I agree that I have read and understand the WVU Office of Student Accommodations statement of confidentiality located at: http://osa.wvu.edu/res/confidentiality.

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