Accommodations Request Intake Form

Asbury University
Academic Accessibility Resources

(Please read and complete carefully)

Thank you for contacting Academic Accessibility Resources (AAR) at Asbury University. You must complete and submit the Intake Form and Release of Information in order to request any academic adjustments.

In addition, please submit professional documentation to support your disability in order for our office to assess what accommodations are reasonable and appropriate. However, please be aware that completing and submitting these forms does not guarantee that you will be provided an accommodation.

It is also your responsibility to schedule an intake appointment with AAR. Please call AAR at 859-858-3511, Ext. 2283 or email the AAR Director at academicaccessibility@asbury.edu.

Accommodations are not retroactive, and some accommodations take longer to implement than others. Students are strongly encouraged to request accommodations well in advance of your course start date or within the first week of class. Notifications several weeks in advance is ideal.

Academic Accessibility Resources (AAR) reviews every student's request, self-report, and documentation to recommend reasonable and appropriate accommodations as necessary to maximize the student's accessibility and participation in each course. We strongly encourage you to complete this form and return it to the AAR Director as soon as possible. Please also provide current, appropriate documentation with this request for accommodation. Attach additional page(s) to this form, if necessary.

Steps to receiving accommodations/adjustments:

Submit completed Intake Form and Release of Information Form.
Submit professional documentation to support your disability in order for AAR to assess what accommodations are reasonable and appropriate. (Please see the Guidelines for Documentation).
Schedule an appointment with AAR by calling 859-858-5850.
AAR reviews and assesses the granting of reasonable and appropriate accommodations.
Implementation of accommodations and notification to professors prior to course start date, or once approved, for mid-term requests.
Continued communication between student, course instructors, AAR Director, and other pertinent staff to ensure student's accessibility and participation in each class.

Student Information

First Name:

Middle Name:

Last Name:

Permanent Address:

Country

Street

City

Region

Postal Code

Phone Number:

Phone Number (Alternate):

Primary Email Address:

Prospective Student:

Prospective 1st Year Student

Prospective transfer

First enrollment or Anticipated Entrance Date:

Major/Program of Study at Asbury University:

Where do you live on campus?

Transfer Student:

Yes

Most recently attended institution:

Academic History

Please list all high schools and college/universities attended with the most recent one first.

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Schools Attended
* School Name: Hidden: School CEEB Code Hidden: School Origin = Academic Accessibility Form Date From: Date From: Date To: Date To:

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