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Student Access Office Forms

Forms

Accommodations Request Form

Accommodations Application

An application must be submitted each semester for all students requesting services. If you do not want to use this online form you may view, complete, save, and/or print a copy of this PDF fill-in form.

Permanent Home Address:

Campus or Local Address:

Emergency Information

Check All That Apply:

Signature

Student Information Form

Student Information Form

This information must be completed by

  • First-time students requesting accommodations

- AND/OR -

  • Students who need to update their information

and it must be returned with complete documentation of disability. If you do want to use this online form, you may view, complete, save, and/or print a copy of the PDF form available at the bottom of this column.

Student Information: Please fill out the following personal information to the best of your ability

I am currently receiving information/assistance from (check all that apply):

Name of counselor/agency contact: (Note: This is only required when you have selected at least one of the first three agencies previously listed):

Medical Information: Proper and current documentation of student's disability must accompany this form.

Emergency Contact Information:

Signature: (Note: The date and time of submission will be recorded automatically)

Interpreter Request Form

Interpreter Request Form

If you do not want to use this online form you may view, save, and/or print a copy of the PDF fill-in form here

Grievance Form

Student Access Office (formerly Disability Services) Grievance Form

If you are filing for another adult, you must provide a signed consent form for that person. Consent forms are available in the Student Access Office (formerly the Disability Services Office).

Please follow the next steps:

After submitting this form please email the following information to the Student Access Office at DSO@avila.edu:

1. Please list each allegation in a separate document (preferably saved as a PDF) with the following information:
-- Describe what happened, when it happened, and whom you feel was responsible.
-- If you refer to persons by name, please include their title.
-- Explain why you believe that the harassing or discriminatory acts were based upon your disability for each act of alleged misconduct.

2. Please attach copies of any written materials, data, or other documents supporting each allegation of disability harassment or discrimination in your email. You may also submit such materials in person to the Student Access Office (formerly the Disability Services Office) in the Student Success Center in Hodes.

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