Connect with Access and Equity

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Student Information

Please enter your information

Legal First NameRequired *

Last NameRequired *

Middle Name

Name

If different from Legal Name

Preferred Pronouns

Student ID NumberRequired *

Please use your SUNY Delhi ID number. Your ID number begins with 800...

SUNY Delhi EmailRequired *

Please use your SUNY Delhi issued email address

Student's Cell Phone NumberRequired *

Term of EntryRequired *

Year of EntryRequired *

Specific Accommodation Information

Must be completed by the student requesting accommodations.

Please check all diagnosed disabilities Required *

Choose all that apply. Please be as accurate as possible.

If other, please specify

If "mental health, chronic medical condition, mobility and/or temporary disability" please specify

Disclosure

The Access and Equity Staff are mandated reporters including in situations where a student expresses the intent of harm to self or others, and where a student discloses sexual harassment, sexual assault, gender-based harassment, stalking, and/or dating violence and domestic violence as outlined in Title IX. Students do not need to disclose any information related to a Title IX incident to request accommodations through Access and Equity.

Are you requesting academic accommodations?Required *

Are you requesting academic accommodations? Yes Are you requesting academic accommodations? No

Are you requesting physical campus access accommodations? Required *

Are you requesting physical campus access accommodations? Yes Are you requesting physical campus access accommodations? No

Are you requesting dining accommodations?Required *

Are you requesting dining accommodations? Yes Are you requesting dining accommodations? No

Are you requesting housing accommodations?Required *

Are you requesting housing accommodations? Yes Are you requesting housing accommodations? No

Describe the accommodation which you believe is necessary for you to have equal access to the campus living environment.

Please describe the disability that necessitates your need to have a housing accommodation.Required *

How does your disability affect your daily living?Required *

academics, housing, dietary, other, etc.

If you had accommodations approved in high school and/or by another college, please list the approved accommodations

What accommodation(s) are you requesting in order to have equal access to the College's services, programs, and/or activities?Required *

Please specify

Do you work with ACCES-VR?Required *

ACCES-VR Counselors Name

ACCES-VR County

How will you provide Access & Equity your documentation?Required *

Psychological/Psychoeducational Evaluations which include your strengths and weaknesses. (Example documentation includes a recent psychological evaluation, IEP, or medical documentation.) OR Medical Documentation of your disability verifying the need for accommodations or support services (if applicable).

I will attach it to this request form. I will email it to accessandequity@delhi.edu. I will have my prior educational institution send it. I've already sent it to Access & Equity. I will have my service provider send it. I'll log back in to Accommodate and upload under Documents. I will bring paper copies to campus. I've already provided paper copies to a Access & Equity staff member.

Upload supporting document(s)

Students are not required to submit documentation at the time they submit this form. No student should delay submitting this form or meeting with Access and Equity out of concern for not having appropriate documentation, though any documentation information students can share before or during the first meeting is helpful. The Access and Equity Office Documentation Guidelines webpage outlines different types of documentation that may be helpful.

Document Information

Document Title

FileRequired *

Maximum file size: 10240kb

Description