Accommodations Request Form | Mount Vernon Nazarene University

General Information

Student First Name

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Student Last Name

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MVNU ID#

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Student Email Address

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Address

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City

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State

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Zip Code

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Cell Phone Number

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Home Phone Number

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MVNU provides equal access to all educational and programmatic activities and abides by section 504 of the Rehabilitation Act of 1973 and the applicable provisions of the Americans with Disabilities Act (ADA) of 1990. The Office of Accessibility Services’ facilitates a process for students to self-disclose documented disabilities and fosters a campus environment that is accessible, inclusive, and regulatorily compliant.

The MVNU Accommodations Process is individualized and considers all information students submit about their disability including self-reports, observable information, and assessments from a qualified professional. Disability diagnoses are confidential unless required by law or a student approves a release of information. Approved accommodations can be shared with appropriate faculty and staff.

The process includes:

this request form
disability documentation/verification
personal intake appointment

All students, including those with disabilities, must meet the qualifications and learning outcomes of their courses and program. Accommodations cannot decrease curriculum elements or alter fundamental program requirements and do not guarantee academic success. Accommodations create equal access and opportunity for success for students with disabilities.

After submitting this form online, your next step is to have verification documentation from a qualified professional sent to MVNU either by email (AccessibilityServices@mvnu.edu) or by fax (740)-399-8684. Please complete this process as quickly as possible as accommodations are not retroactive. (MNVU accepts a variety of verification documents. Please see details and template forms at www.mvnu.edu/accessibilityservices. If your disability and needed accommodations are clearly observable and related, no verification form is needed.) Most accommodations can be put in place within two weeks but some can take up to six weeks so submit the request form and verification document promptly.

Once reasonable accommodations are determined, an official Letter of Accommodations is created for distribution to appropriate faculty and staff. MVNU reserves the right to request further documentation to determine reasonable accommodations.

Please list your disability or disabilities and note for each if it is chronic or temporary

How does your disability and/or associated medication affect you academically, residentially, or in campus programs, services (such as food), or physical buildings or spaces?

The learning outcomes and instruction methods (online/in-seat, program type, length, etc.) of each activity, program, or course are considered with accommodation requests. The potential accommodations listed below are ones commonly provided but are not meant to be an exclusive list. Some may not be deemed reasonable in every activity, program, or course.

Please list the Academic Accommodations you are requesting such as: use of computer for notes and/or tests/quizzes, peer notes, audio recording lectures, texts in audio ready formats, extended time on tests/quizzes, scribe and/or reader for tests/quizzes, low distraction testing space, private testing room, early registration, large print, preferred seating, interpreter, braille, closed captioning, modified attendance, practicum/field/clinical/internship accommodations, etc.

Please list the Housing Accommodations you are requesting such as: emotional support animal, accessible residence hall room/bathroom/shower, single room for medical reasons, etc.

Please list the Dietary Accommodations you are requesting such as: fresh gloves/utensils in meal preparation/serving, meals prepared in separate area to avoid cross-contamination, specially purchased food for student’s dietary needs, individually prepared meals. If student cannot safely eat in shared space, possible accommodations include an extra refrigerator in residence hall room, shared kitchen access, private kitchen access, approval to live off campus, partial or full meal plan exemptions, etc.

Attachments for the Accessibility Office