Accessibility Resources Blue Ash- Online Application for Services

Home College: Select the College of your primary major

Intended Major:

Current student status

Incoming Student (Freshman or Transfer Student starting Fall 2020)

Returning Student

Other...

What semester are you requesting academic accommodations start in? (If you're an incoming Freshman starting in Fall 2020 please select Fall 2020)

Spring 2020

Summer 2020

Fall 2020

Other...

Are you a Distance Learner? (Example: All of your courses are online)

Yes

No

Are you seeking permanent or temporary accommodations? (Temporary accommodations would be for injuries, surgeries, temporary conditions etc.)

Temporary

Permanent

For what disbaility are you seeking accommodations?

How does your disability impact you in the academic setting? (Examples: test-taking, class attendance, taking notes, understanding materials, speaking, comprehension, etc.)

During your intake interview, will you require any accommodations? Please list any accommodations you would like to request.

List and describe (if applicable) any other areas of University Life that might be impacted by the disability (housing, transportation, building accessibility, parking, etc.)

Are you transferring from a University of Cincinnati branch campus?

No

UC Clermont

UC Clifton

If yes, did you receive accommodations at that campus?

Yes

No

Did you receive special education services or accommodations in K-12 or at another post-secondary education institution? If so, check all that apply:

None

50% Extended Time on Testing

100% Extended Time on Testing

Distraction Reduced Testing Environment (small group)

Individual Testing Room

Reader

Scribe

Use of a Computer (during class or testing)

Enlarged Font

FM System

ASL Interpreter

Captioning

Communication Access Realtime Translation (CART)

Accessible Furniture

Excused Medical Absences

Extended Time on Assignments

Alternative Format Textbooks

Tape Recorder

Notetaker

Assistive Technology

Other...

If deemed eligible for services, what accommodation(s) are you requesting from Accessibility Resources?

None

50% Extended Time on Testing

100% Extended Time on Testing

Distraction Reduced Testing Environment (small group)

Individual Testing Room

Reader

Scribe

Use of a Computer (during class or testing)

Enlarged Font

FM System

ASL Interpreter

Captioning

Communication Access Realtime Translation (CART)

Accessible Furniture

Excused Medical Absences

Extended Time on Assignments

Alternative Format Textbooks

Tape Recorder

Notetaker

Assistive Technology

Other...

Are you working with any external support networks or organizations? (Example: Vocational Rehabilitation Services, Veterans Services, etc.). If so, what services or assistance are they providing?

Have you been prescribed medication applicable to your disability? If yes, how does the medication impact your daily function and /or academic work?

What areas do you excel at and enjoy (academic, social, other) at the University of Cincinnati? Please explain.

What areas are more challenging for you (academic, social, other)? Please explain

Please share any additional information you would like to provide.

Medical Professional Disability Verification Form or Supporting Disability Documentation

Please upload your Medical Professional Disability Verfication form or documentation supporting your request for accommodation that meets Accessibility Resource's documentation guidelines. Note: JPEG, PNG, or other image files containing photographs of documentation will not be accepted and may delay review of your documentation. Please provide scanned PDF or digital documents.

Additional Documents: Upload any additional documentation, assessments, etc. in support of your request for academic accommodations

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