Disability Disclosure and Reasonable Accomodations Form

To apply for reasonable accommodations, complete this application. After submitting the form please provide documentation of your disability to the Office of Educational Support and Disability Services by fax, mail, email or in-person. After it is received, the Office of Educational Support and Disability Services will evaluate your documentation and consult with the University of Maryland School where you will be taking classes. We will contact you for an appointment, if necessary, to discuss your disability-related needs and requests.

CONTACT INFORMATION

Other:
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DISABILITY DISCLOSURE:
Please disclose the nature of your disability or disabilities, reasonable accommodations you are requesting at the University of Maryland, and how these accommodations will help you. This section is required to be completed every semester and should be used to also explain how your needs may have changed over time.
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COURSE ACCOMODATION REQUEST:
For each course you will be enrolled in during the semester provide the course number, course name, the faculty member teaching the course, and a description of the types of accommodations you are requesting. Please note that if your needs change during the semester you should contact the Office of Disability Services to alter any approved reasonable accommodations.
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NOTICE:
While a student's request for a specific type of accommodation will be considered, the student's school and program may propose alternatives. Consequently, the reasonable accommodation offered and provided may be different from what the student has requested. A student may disclose and request reasonable accommodation at any time but should consider that it may take several weeks or longer to complete the disability accommodation process. Because reasonable accommodations are not provided or applied retroactively, a student should take into consideration the appropriateness of attempting to progress before a plan for reasonable accommodation has been approved and implemented.
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REQUIRED DOCUMENTATION:
In order to receive consideration for academic accommodations based on a disability, please provide documentation from an appropriate professional describing your disability. Please refer to the Documentation Guidelines. You may find it helpful to offer a copy of these guidelines to the professional providing documentation on your behalf.
In order to receive consideration for academic accommodations based on a disability, the Office of Educational Support and Disability Services (ESDS) needs information documenting the disability. The professional documentation is kept at all times in a locked, private file at the ESDS. To protect privacy, direct access to this documentation is by written consent only. The ESDS will determine what information needs to be shared with University staff and faculty, on an "as needed basis," in order to assess and/or facilitate academic accommodations or other services. The following are the general guidelines for the contents of the documentation:
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RELEASE OF INFORMATION AUTHORIZATION AND SIGNATURE:
Submission of this Disability Disclosure and Reasonable Accommodations Form will authorize the Office of Educational Support and Disability Services at the University of Maryland to engage in the interactive process of reasonable accommodation and discuss documentation and other information obtained/submitted to our office with providers such as licensed physicians, psychologists, or other qualified professionals, and to discuss your disability with other faculty and staff at the University of Maryland.
For the purposes of disability disclosure and reasonable accommodation, I hereby authorize the UM Office of Educational Support and Disability Services to use, disclose, and exchange information from my educational records, including information relating to my disability and my request for accommodation with my provider(s) (physician, psychologist, or other qualified professional), and to faculty and staff of UM and my School. My authorization will remain in effect for the duration of my enrollment. I understand that I may revoke my authorization at any time by informing the Office of Educational Support and Disability Services. My revocation will be effective upon receipt, except to the extent that UM or my School has taken action in reliance upon my authorization prior to revocation. I understand that this information will assist those who are helping with my education and request for accommodation(s), and that my refusal to provide authorization may result in a denial of specific accommodations.