Print Forms to register with the disability services office: Word | PDF

Requesting Academic and Environmental Accommodations

Fitchburg State University encourages students with disabilities to participate fully in all academic programs and student activities. The Office of Disability Services works with students, faculty, and staff to remove barriers to access and encourage universal design. Our primary objective is to promote independence, build skills, and facilitate achievement of educational goals for individuals with disabilities. Disability Services also serves the campus community as a resource center for medical and legal advocacy, information, and referrals.

Disability Services is responsible for verifying student eligibility for accommodations and for coordinating accommodations across campus. Students must request services themselves and must provide appropriate documentation to support the need for such services.

To obtain academic and/or environmental accommodations, please do the following:

Step 1: Obtain up to date copies of your medical documentation and complete the Office of Disability Services forms

Once you have obtained copies of your disability documentation from your high school (or from the medical provider who is most familiar with your needs and your disability) complete and sign the Statement of Learning Needs and Release of Information forms. Documentation must clearly state your diagnosis, describe the symptoms which impact your ability to function in the educational environment and provide specific recommendations for accommodations. All documentation received by the university is strictly confidential and is held in accordance with the Family Educational Rights and Privacy Act (FERPA) and related regulations.

Step 2: Meet with the coordinator and make a plan

Bring forms, along with copies of your medical documentation, to Disability Services for processing. Based on information provided by you, in combination with information from your medical documentation, we will draft an Accommodation Agreement that outlines what specific accommodations you are eligible for. You can then present this plan to your course instructors each semester to advise them of your needs. Please be aware that some accommodations may take up to 12 weeks to obtain, so students are strongly advised to meet with the director and establish eligibility well before the semester begins. If you have any questions about Disability Documentation Guidelines or this process, please do not hesitate to contact us for support.

We are glad you are here and look forward to working with you!

• Forms for Registering with Disability Services: Word | PDF

• Disability Documentation Guidelines
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Forms for registering with Disability Services

Registering with the Office of Disability Services Student Checklist

_____ Gather copies of your disability documentation (for example, psycho-educational testing, relevant medical reports, etc.)

_____ Tell us about your learning needs (fill out the Statement of Learning Needs).

_____ Complete the Release of Information. Provide information relevant to the medical documentation that you are submitting to the office to establish your eligibility for disability services.

_____ Submit copies of your disability documentation along with Disability Services forms (Statement of Learning Needs and Release of Information) to the Office of Disability Services for processing.

_____ Contact the Office of Disability Services to confirm that all of your paperwork was received.

_____ Schedule an appointment to meet with the director of Disability Services to develop your accommodation agreement (Section 504/ADA Plan).

_____ Provide your instructors with copies of your accommodation agreement (Section 504/ADA Plan). Meet with each instructor early in the semester to discuss your specific needs.

_____ Work closely with the Office of Disability Services and your course instructors throughout the semester to insure your academic success at Fitchburg State University.

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Eligibility for Disability Services: Release of Information

This form provides Fitchburg State University with your permission to review medical documentation and consult with diagnosticians and/or practitioners about your disability.

Please fill in information about the documentation that you are providing to establish your need for services. Also include information about any other individuals that you would like us to confer with about your disability. All documentation received by the University is strictly confidential and is held in accordance with the Family Educational Rights and Privacy Act (FERPA) and related regulations.

If providing us with documentation (such as a psycho-educational evaluation) from a high school/K-12:

School ________________________________________________________________________

Street _________________ City ____________________ State ______ Zip _________

Phone Number _______________ Name and credentials of evaluator

If providing us with recent medical documentation from a clinic or hospital:

Doctor/Psychiatrist/Therapist _________________________________________________________________

Street ____________________________________City ____________________ State ______ Zip __________

Phone Number ______________________ Clinic/Hospital Affiliation _________________________________

If you would like us to be able to confer with a counselor or personal coach who is working with you:

Agency (i.e. Massachusetts Rehabilitation) ______________________________________________________

Street ________________________________City ____________________ State ______ Zip ___________

Phone Number _____________Name of counselor & title _________________

Note: Students are responsible for following up with their high schools and/or medical practitioners in obtaining and/or photocopying documents. Requests for accommodations will be processed when all completed forms have been submitted along with supporting medical documentation. Accommodations will be initiated after an eligibility review and intake evaluation has been completed.

I give Fitchburg State University permission to review and retain educationally related diagnostic information, such as medical records, professional evaluations, and educational plans. I realize that this information will be reviewed by the director of Disability Services and will be kept separate from my academic records.

Signature of Student _____________________ Date _______________

Name (print) __________ Date of Birth __________SSN or Student ID______________

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Statement of Learning Needs

Fitchburg State University offers accommodations for eligible students with documented disabilities. To request academic or environmental accommodations, complete both sides of this form and return it along with copies of your disability documentation to:

Disability Services, Fitchburg State University, 160 Pearl Street, Fitchburg, MA 01420

Voluntary Disability Disclosure

Name ______________Birth Date _________ Student ID # _________________

Street _____________City _______________ State _____ Zip __________

Phone _____________________________ Email __________________________

If not yet a Fitchburg State student, when do you plan to attend? ______________

What type of disability/disabilities are you requesting accommodations for? Please check all that apply.

Learning Disability Psychological/Emotional Disability Physical Disability

In your own words, please describe your disability and any symptoms which impact you in the academic and/or residence hall environment. Attach additional pages if necessary.

Disability Diagnosis/Diagnoses:

Symptoms of this disability that could interfere with your academic success:

Request for Disability Accommodations

Please check any services that you require as a result of your disability and briefly describe them. All requests must be supported by recent and relevant medical documentation. For detailed information about what disability accommodations are available at Fitchburg State, please visit the Disability Services page on the university Website or contact the office directly at (978) 665-4020 (Voice/Relay).

_____ Testing Accommodations (describe) ___________

_____ Adaptive Technology (describe) ___________________

_____ Communication Devices (describe) __________________

_____ Alternate Format Materials (describe) _________________

_____ Residence Hall Accommodations (describe) ________________

_____ Other (please specify) __________________________

Please Note:
For handicapped parking information, please visit the Fitchburg State University campus map.