ACCOMODATION REQUEST

Humphreys University welcomes students with disabilities and is fully committed to complying with the laws regarding equal opportunity for all qualified students with disabilities and promoting the full participation of all qualified students in all aspects of campus life.

All students are expected to meet the academic standards as developed by the faculty. It is only through a student’s voluntary disclosure of a documented disability or injury and a request for accommodation that Humphreys can support the student’s needs.

Once you complete this fillable form, your dean will contact you to discuss which accommodations or modifications would be most effective to help you achieve academic success. A team will develop and arrange accommodation or modification. You will be notified through your student email of approved accommodation or modification.

ACCOMODATION REQUEST

Humphreys University welcomes students with disabilities and is fully committed to complying with the laws regarding equal opportunity for all qualified students with disabilities and promoting the full participation of all qualified students in all aspects of campus life.

All students are expected to meet the academic standards as developed by the faculty. It is only through a student’s voluntary disclosure of a documented disability or injury and a request for accommodation that Humphreys can support the student’s needs.

Once you complete this fillable form, your dean will contact you to discuss which accommodations or modifications would be most effective to help you achieve academic success. A team will develop and arrange accommodation or modification. You will be notified through your student email of approved accommodation or modification.

STUDENT INFORMATION

First Name *

Middle Name

Last Name *

Student ID * 🛈

Phone Number *

Email Address *

Uploaded Documentation Needed *

Notes *

Please read and initial the following information taken directly from the Humphreys University Academic Catalog.

To seek an accommodation, a student must make a written request to the Dean and provide appropriate medical documentation of his/her disability. The Dean may request additional documentation if what is provided is incomplete or if there are questions or inconsistencies with the student’s current impairment status and a requested accommodation. Appropriate medical documentation must include a written evaluation from a physician, psychologist, or other qualified specialist that establishes the nature and extent of the disability and includes the basis for the diagnosis and dates of testing; establishes the current need for accommodation; clearly identifies the diagnosed disability or disabilities; describes the functional limitations resulting from the disability or disabilities; describes the specific accommodation requested; and is typed or printed on official letterhead and is signed by an evaluator qualified to make the diagnosis, including licensure or certification and area of specialization. *

I acknowledge that the information above is accurate and complete.

Student Signature *

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Date * +