wayne state college federal law, a person with a disability is any person who: 1) has a physical or...
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Wayne State College
Disability Services Handbook
Dedicated to Student Success
Library 232
Holland Academic Success Center 402-375-7496
https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
2
Disability Services Handbook
Disability Services Handbook
Table of Contents
1. Disability Services Mission Statement
a. Disability Services Office Functions
2. Federal Law
a. Rehabilitation Act of 1973, Section 504
b. Americans with Disabilities Act of 1990, as amended in 2008
c. US Department of Housing and Urban Development Fair Housing Act of 1968, as amended in 1988
3. Student Code of Conduct
a. WSC Student Handbook
b. WSC General and Graduate Catalog
c. WSC Behavioral Intervention Team
4. Academic Standards
a. Using Exam Modifications
5. Academic Accommodation Policy
a. Student Responsibilities
b. Disability Services staff’s Responsibilities
c. Faculty Responsibilities
d. Review (appeal) Process
6. Hearing Impairment
a. Services Provided
i. Technology Support
b. How to Request Services
c. Attendance Protocol
i. Interpreter Scheduling/Notification ii. No-Show
Warning
d. Resolving Problems
8. Attachments
a. Accommodation Request Form
b. Temporary Conditions Accommodation Request Form
c. Interpreter Service Request Form
d. Exam Accommodation Request Form
e. Campus Resource Page
It is the mission of the Wayne State College Disability Services program to assist students with disabilities in
reducing physical, programmatic and attitudinal barriers that might otherwise impede a student's success
at Wayne State College (WSC). It is the goal of the WSC Disability Services Program to provide WSC
students with disabilities with an equal opportunity to participate in the educational process and campus
life of Wayne State College. The goal will be achieved through the provision of disability-related academic
and personal support services.
FUNCTIONS
The Disability Services Program is housed in the Holland Academic Success located in the Library 232.
Disability Services core functions take into consideration the diverse nature of the impact of disabilities
within the educational environment as well as the availability of college resources. The core functions of
Disability Services are noted below.
1. Determining Student Eligibility for Disability-Related Accommodations and Services The staff meets
individually with students to verify eligibility for accommodations/services and to assess individual
needs. Written documentation of disability is requested, reviewed and evaluated prior to determining a
student's eligibility for accommodations/services. The staff will obtain and review written
documentation of disability, determine eligibility for coverage under Section 504 and the ADA,
determine the student's understanding of his/her disability, determine what disability services have
been used previously, assess how/if the student's disability affects his/her access to WSC's academic,
cultural, and recreational activities. Arrangements can be made to re-assess students when needed.
2. Referral to Appropriate Campus/Community Resources
Following a determination of the student's eligibility, additional information is gathered from and provided
to the student. Referrals are made to appropriate campus and/or community services. The staff will explain
the student's rights as individual with a disability, inform him/her of eligibility for accommodations/services,
recommend an appropriate combination of accommodations and services, refer to specific
campus/community resources, and then follow-up to determine student use and satisfaction.
3. Responding to Requests for Physical and Program Access and Accommodation
The following information will be considered to determine the effectiveness and appropriateness of
accommodation requests:
a) The individual with the disability.
b) Educational impact of disabling conditions.
c) The campus environment.
The staff will directly consult with a wide variety of WSC staff in order to determine the appropriateness of
a student's request for accommodation. The staff will identify the source of problems/concerns related to
disability, consulting with individuals involved, develop a range of possible accommodations, provide direct
services to students, and refer to other offices when appropriate. Students will be encouraged to address
problems/concerns, follow recommended actions, policies or procedures to resolve identified issues.
Disability Services Handbook 10
Federal Law
Section 504 of the Rehabilitation Act of 1973
Title V of the Rehabilitation Act of 1973 is generally regarded as the first federal "civil rights" statute for
people with disabilities. Title V mandates nondiscrimination in federal agencies (Section 501) and the
establishment of the Architectural and Transportation Barriers Compliance Board (Section 502). Of most
direct importance to the postsecondary education community are Sections 503 and 504.
Section 503: Section 503 prohibits discrimination on the basis of disability in employment in institutions
that receive federal funding. Section 503 is not an affirmative action statute and does not include a
requirement to give preference in employment to qualified people with disabilities. Section 503 does,
however, include a mandate to actively encourage application and consideration for employment of
disabled candidates.
Section 504: Section 504 of the Rehabilitation Act of 1973 is a program access statute that is designed to
ensure that programs receiving Federal funding be accessible to students with disabilities. The legislation
states that:
"No otherwise qualified handicapped individual in the United States shall, solely by reason of his
handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination
under any program or activity receiving Federal Financial Assistance..."
It is this Section 504 mandate that has prompted the development of disability support services and
programs in colleges and universities across the United States. Subpart E of Section 504 deals specifically
with postsecondary educational institutions. Although it does not require special educational
programming be created for disabled college students, it does require that an institution (public or
private) be prepared to make appropriate adjustments and reasonable modifications to policies and
practices in order to allow the full participation of students with disabilities in the same programs and
activities available to nondisabled students.
Tests which the institution uses must not discriminate against students with disabilities. Tests must be
selected and administered so that the results for students with impaired sensory, manual, speaking
and/or information processing skills are not distorted and so that the tests accurately measure the
student's achievement or knowledge level rather than his/her disability. Thus, academic ability must be
the sole basis for participation in postsecondary education.
In order to ensure equal opportunity, the overall postsecondary educational experience of a student
with a disability must be comparable to that of his/her non-disabled peers. This may necessitate
different treatment in some situations.
ACCESSIBILITY: THE KEY TO EQUAL OPPORTUNITY
Disability Services Handbook 11
Americans with Disabilities Act of 1990, amended in 2009
Assurance of equal educational opportunity rests upon legal foundations established by federal law,
specifically the Rehabilitation Act of 1973 including Section 504, and the Americans with Disabilities Act
(ADA) of 1990 as amended in 2008. By federal law, a person with a disability is any person who: 1) has a
physical or mental impairment; 2) has a record of such impairment; or 3) is regarded as having such an
impairment which substantially limits one or more major life activities such as self-care, walking, seeing,
hearing, speaking, breathing, or learning.
Every student with a documented disability has the following rights:
• Equal access to courses, programs, services, jobs, activities, and facilities available through the
college or university.
• Reasonable and appropriate accommodations, academic adjustments, and/or auxiliary aids
determined on a case-by-case basis.
• Appropriate confidentiality of all information pertaining to his/her disability with the choice of
whom to disclose their disability except as required by law.
• Information reasonably available in accessible formats.
The US Department of Education provides guidance for the implementation of The Americans with
Disabilities Act (ADA) as amended in 2008. The guidelines are in the form of Dear colleague Letters,
Question and Answer statements, and familiarity with the Office of Civil Rights which enforces civil rights
laws for programs or activities that receive Federal Funds from the Department of Education.
http://www2.ed.gov/policy/rights/guid/ocr/disability.html
DOCUMENTATION Students requesting accommodations MUST PROVIDE DOCUMENTATION regarding their disability. This documentation should identify how the disability impacts the learning process. Guidelines regarding documentation can be found at: https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
Personal needs such as assistance with meals, homework, toileting, personal hygiene, etc. are the
exclusive responsibility of the student. These are not included as reasonable accommodations under
the law.
ACADEMIC ACCOMMODATION A reasonable accommodation is a modification or adjustment to a course, program, service, job, activity,
or facility that enables a qualified student with a disability to have an equal opportunity. An equal
opportunity means an opportunity to attain the same level of performance or to enjoy equal benefits
and privileges as are available to a similarly-situated student without a disability. The college is obligated
to make a reasonable accommodation only to the known limitations of an otherwise qualified student
with a disability.
Disability Services Handbook 12
U.S. Department of Housing and Urban Development Fair Housing Act of 1968, as amended in 1988 http://portal.hud.gov/hudportal/HUD?src=/program_offices/fair_housing_equal_opp/FHLaws/yourright
s
Students may request reasonable accommodations to residence hall rooms or common use areas for
health and safety reasons. These accommodations can include but is not limited to the addition of
alternative alarm systems in student rooms, and safety bars, changing tables, etc. in restroom facilities.
Students with visual impairments or other documented disabilities are allowed to keep service animals
in their residence hall room.
ACCOMMODATION DECISION MODEL
Disability Services Handbook 13
Student Code of Academic and Behavioral Conduct
WSC Student Handbook available on line:
http://www.wsc.edu/catalogs_publications/student_handbook/student_handbook.pdf
Students are responsible to obey the laws of the state and nation, the regulations and policies of the
Nebraska State College System Board and of the Colleges; and to refrain from any conduct injurious to
themselves, to others, or to the reputation or interests of the College. (Board Policy 3100)
http://www.nscs.edu/policy-manual.htm
WSC General Catalog Student’s Responsibility Statement: Students are expected to read the regulations of the College and to
conform to them. The student, not the College or a member of the faculty, is primarily responsible for
meeting requirements for a degree.
Registration and payment of fees imply an agreement by the student to conform to regulations of the
College. Students failing to meet current obligations to the College, financial or otherwise, may be
denied a degree or transcript.
http://www.wsc.edu/catalogs_publications/general_course_catalog/gen_catalog.pdf
WSC Disability Services on the Web Student Handbook description of Disability Services is available online
http://www.wsc.edu/catalogs_publications/student_handbook/student_handbook.pdf
More detail is available on the WSC Disability Services website
https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
WSC Behavioral Intervention Team Wayne State College is committed to providing a safe educational environment for all students and
employees. The Behavioral Intervention Team (BIT) serves as an information clearinghouse and early
intervention vehicle to assess and manage potentially dangerous situations and to assist students
experiencing difficulty. The team also serves as a resource to faculty, staff, and students who may have
a concern about another member of the campus community. Referrals to the BIT may be made by any
member of campus community by contacting the Dean of Students. Information received will be
handled confidentially, with the purpose of assisting the student, faculty, or staff person named. The
regular meetings allow each part of the team to react in a timely manner to campus issues.
Disability Services Handbook 14
The Behavioral Intervention Team (BIT) members include Campus Security, Wayne Police Department,
Counseling, Residence Life and Student Services representatives.
Protection of Academic Standards
Use of Exam Modifications for College Students with Disabilities
Measurement of student learning in the classroom is an essential component of the educational process.
However, not all students can be evaluated fairly using standardized testing procedures. For students
with disabilities, modifications in general testing procedures may be needed.
Students of average or above average ability may have any of a variety of conditions that substantially
impact the usefulness and accuracy of generally used measurement instruments. Disabilities, including
dysfunctions of hearing, learning, vision or mobility can interfere with a student's ability to manage
exam instructions, materials or mode of response. For these students, the use of modified testing
procedures; adapted for the individual, provide a more fair and accurate means of measuring student
learning.
Exam accommodations must not compromise academic standards. Otherwise stated, modifications
must not give the student a competitive edge. Rather, the modification must eliminate a competitive
disadvantage that results from the interaction of the testing procedures and the student's disability. The
objective of appropriate accommodations is to provide the instructor with a means of evaluating the
student's understanding of content rather than his or her functional limitations.
At the outset of a semester, both the student and the instructor may be uncertain about how to
determine and provide appropriate accommodations. They may even be unsure whether a proposed
exam modification is warranted. The determination of exam modifications that are reasonable and
mutually agreeable does not lend itself to strict policies and regulations. Specific information about the
student's disability, the course requirements, and the method of evaluation must all be considered
when designing modifications.
Faculty members are encouraged to consult with campus Disability Services staff regarding the need for
exam modifications. The staff are typically knowledgeable about the individual and the disability, have
access to the confidential information necessary to make a determination of the appropriateness of an
exam modification, have experience in determining/recommending specific modifications and thus can
provide approaches that are both fair and equitable.
The following statement is an example of the type of announcement that can be made at the first few
class sessions of each semester and can be included in print as a standard part of the course syllabus:
Disability Services Handbook 15
If you need academic accommodations because of a disability, please inform me as soon as possible. See me privately after class or during my office hours for a confidential conversation. To request accommodations, students must first consult Julie Bose located in the Holland Academic Success Center, Library 232 or by calling 402-375-7496 or email [email protected]. The Disability Services staff is responsible for reviewing documentation provided by students requesting accommodations, determining eligibility for accommodations and helping students request and use appropriate accommodations.
Although it is the student's responsibility to discuss accommodations with the instructor, some students
are reluctant to do so. The routine use of this statement may encourage hesitant students to approach
the instructor in a timely manner and it also makes the entire class aware that people with disabilities
are an integral part of the campus community.
Early identification of students with disabilities is a substantial advantage, allowing faculty, students and
disability staff adequate time to consult, determine the appropriateness of and arrange any classroom
modifications needed. Through the joint efforts of the student, the instructor and the appropriate
campus staff, fair and equitable accommodations can be arranged which do not compromise academic
standards.
ACADEMIC ACCOMMODATION POLICY Wayne State College (WSC) is mandated to provide equal opportunity for individuals with disabilities as
indicated in Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA)
of 1990 and as amended by the ADA Amendments Act of 2008. An academic accommodation or
modification is sometimes needed to ensure that a qualified student with a disability has an equal
opportunity to access and benefit from a course or educational activity. However, academic
accommodations must not compromise the college’s academic standards.
At WSC, the academic accommodation process involves a partnership between the student, the WSC
Disabilities Services staff, and the faculty member. Each has a specific role to play and responsibilities to
uphold.
Student Responsibilities: The student’s role is to make his/her disability known and to request assistance.
1. Provide recent medical, psychological, psychoeducational, or neurological documentation to the
Disability Services Office. Documentation should be from an appropriately licensed professional
which identifies the disability and, whenever possible, provides suggested accommodations.
2. Complete the Disability Accommodation Request Form and receive approval from the
Disabilities Services staff for academic accommodations prior to requesting an accommodation
from a course instructor.
Disability Services Handbook 16
3. Request disability related academic accommodations in a timely manner. This may include
contacting the Disabilities Services staff to arrange exam accommodations.
4. Meet the time limits and procedural requirements established by the Disability Services Office
for providing academic accommodations or scheduling exams. If the student fails to provide
adequate notice of the need for accommodation, he/she remains entitled to the
accommodation, however, the accommodation may be delayed and/or may not be able to be
provided in the fullest measure requested.
Disabilities Services Staff’s Responsibilities: The Disabilities Services staff’s role is to verify the disability and determine the student’s eligibility for
academic accommodations.
1. Determine appropriate academic accommodations using the Disability Accommodation Request
Form.
2. Communicate a student’s eligibility for academic accommodations, upon request.
3. Consult with faculty, staff, and outside professionals regarding academic accommodation
requests that are unusual or complex.
4. Maintain records that verify the disability.
Faculty Member Responsibilities: The faculty member’s role is to provide appropriate accommodations either directly or by making
arrangements with the Disabilities Services staff.
1. Ensure that the requested accommodation does not unduly compromise an essential element or
evaluation standard of the course.
2. Verify that the Disabilities Services staff has approved the requested accommodation.
3. Discuss with the Disabilities Services staff any concerns related to an accommodation or the
arrangements that have been requested by a student with a disability.
4. When the exam is to be administered by someone other than the faculty member, determine
the non-disability related conditions under which the exam is to be completed (e.g., open book,
use of notes, calculator) and provide timely delivery of the exam, along with all necessary
instructions for exam administration.
5. Maintain confidentiality of information regarding students with disabilities.
Accommodation Scheduling: Students eligible for accommodations related to class exams will be accommodated as close to the
scheduled time for the class and/or exam whenever possible. Students will reserve testing times at the
Disability Services Office. During peak times of the semester (i.e., mid-term and finals) it will be
Disability Services Handbook 17
important for students to sign up for their testing appointments as soon as their exam dates and times
are announced in class. Testing time periods will be filled on a first-come, first-served basis. Students
will then be offered the next open testing time that fits their schedule.
Accommodation Appeals: Wayne State College is committed to fair resolution of all requests.
In situations where the appropriateness of a proposed accommodation is unclear, the faculty member or
the student may request a review of the accommodation. The review will be conducted by the Vice
President for Academic Affairs and the Counseling Center Clinical Psychologist. The review committee
will determine whether the requested accommodation is reasonable and appropriate for the student’s
disability and will determine whether the proposed accommodation unduly compromises an essential
element or evaluation standard of the course.
Disability Services Handbook 20
Disability Services Handbook
Accommodation
Review: or Faculty
student may request an of review
accommodation.
Disposition decision o
review comm final. All par notified of decision
Individuals who believe they have experienced discrimi
grievance with the Wayne S
Disability Services Staff
Julie Bose
H olland Academic Success Center
L ibrary 232
Appeals Process
Team: The Vice President for
Academic Affairs and the Counseling
Center Clinical
Psychologist constitute the Review Team.
The
.
ADA Compliance Officer
Human Resources
Hahn 2 nd Floor
402 - 375 - 7403
11
The request is reviewed by a team.
Disability Services Handbook 23
Hearing Impairment
1. Services Offered: Sign Language interpreting will be provided to students with a documented hearing loss.
Interpreters may be offered in-person or via remote interpreting delivered electronically.
a. Technology support: WSC provided technology support services for students relying on electronic
devices to deliver/amplify instruction, connect remote services to student’s personal electronic
device (laptop, tablet, etc.) and provide other supportive functions (e.g., alternative fire alarm).
2. Requesting Service: Interpreter services will be provided for all academic settings directly related to a class
(i.e., Class time, class assignments, instructor-generated review sessions but not peer study sessions).
Check with the Disability Services staff for clarification.
a. Students must meet with the Disability Services staff to request assistance each semester.
b. Students must present a copy of their class schedule as soon after pre-registration as possible to
allow time to arrange interpreter services.
Students who wish to use interpreter services outside of scheduled classes must complete an Interpreter Service
Request Form rather than the more general Accommodation Request Form. The forms are available in the
Disability Services Office or on-line at
https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
c. Completed forms and all other information may be submitted in person, faxed to 402-375-7496 or
sent via mail to [email protected]
d. Exam accommodation requests need to be submitted each semester – see Exam Accommodation
Request Form
3. Attendance Protocol: Students must report class absence to the Disability Services Office and make a good faith effort to cancel need for interpreting services for that class, for the day or time period when an interpreter has been made available but will not be needed (e.g. illness, medical appointment, family emergency, etc.).
4. Resolving Problems: Students are encouraged to resolve problems with the other party in the dispute.
Easy resolution is not always possible.
a. Discuss the conflict with the other party.
b. Students may request assistance from the Disability Services staff to resolve disputes.
c. Students have the right to appeal an accommodation. See appeal description described on
previous pages of this document and/or refer to the WSC Student Handbook and/or the WSC
General Catalog.
Disability Services Handbook 24
Wayne State College Disability Services Accommodation Request Form
Holland Academic Success Center, Library 232, 402-375-7496
This form is your opportunity to describe your disability and accommodations you hope to receive. You may
supplement this form with additional information describing your disability and requested accommodations. (Please
attach additional paper.) You may want to include information about experiences related to your disability, barriers
you faced, and/or previous accommodations (effective or ineffective).
Student Contact Information:
Full Name: _______________________________________________________________________________
Student Identification #: ______________________________ Birthdate: _____________________________
WSC Email Address________________________________________________________________________
Student’s Phone Number(s):_________________________________________________________________ (Home) (Mobile) (Work)
Local Address: ____________________________________________________________________________ (Street) (City) (State)
Permanent Address: _______________________________________________________________________
Emergency Contact: _______________________________________________________________________ (Name) (Relationship) (Phone #)
Year/Term for which you are requesting services: _________________________________________________
Disability Information:
What is your disability or disabilities? __________________________________________________________
________________________________________________________________________________________
In your own words, please describe your disability.________________________________________________
________________________________________________________________________________________
Disability Services Handbook 25
Are you submitting other information or documentation with this form? Yes ___ No___
Potential Accommodations/Adjustments:
What accommodations/services do you hope to receive? ___________________________________________
________________________________________________________________________________________
(Page 1 of 2)
What accommodations/services/assistive technology have you used in the past? ______________________
_______________________________________________________________________________________
________________________________________________________________________________________
Are you currently affiliated with and/or receiving services from any of the following campus offices or programs?
o Student Health o TRIO Student Support Services
o Other
Do you receive services from any of the following agencies?
o Vocational Rehabilitation o Other:
_________________________________________________________________________________
Referral Information:
Who referred you to our office? ______________________________________________________________
________________________________________________________________________________________
Additional Documentation:
Additional documentation should be submitted with this form and can include assessments, reports, and/or letters
from qualified evaluators, professionals, or institutions. Common sources of documentation are health care
providers, psychologists, diagnosticians, and/or information from a previous school (e.g., accommodation
agreements/letters, 504, IEP, or ARD documents). Students are encouraged to submit other disability-related
documentation that will help Disability Services better understand their needs. For more information please refer
to the Documentation Guidelines available on the Disability Services website,
https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
Submitting Information:
Disability Services will consider all relevant information submitted by the student. If you have questions about the
office or the process for requesting accommodations, please contact Disability Services at (402) 375-7496. This form
and all other information may be submitted in person, faxed to (402) 375-7079 or sent via mail to
Disability Services Handbook 26
Comments: ______________________________________________________________________________
________________________________________________________________________________________
I certify that all information I have provided is true and accurate to the best of my knowledge. I understand that
intentionally providing false or misleading information may result in my being ineligible for services and may also
result in disciplinary action by Judicial Affairs.
______________________________________________ _________________________________________
Signature of Student Date
(Page 2 of 2)
Wayne State College Disability Services Temporary Conditions Accommodation Request Form
Holland Academic Success Center, Library 232, 42-375-7496
The Office of Student Disability Services provides accommodations to students with temporary disabilities arising
from injury, surgery, or short-term medical conditions. To receive accommodations for a temporary disability, the
individual must submit a note from either their personal physician or Student Health to our office indicating the
type of disability, limitations, prognosis, and estimated duration. Additionally, the student should contact all
instructors to discuss means of completing class requirements and exams during the period of temporary disability.
Student Contact Information:
Full Name: __________________________________________________________________
Student Identification #:_____________________________ Birthdate: ____________________
Local Address: ___________________________________________________________________
Phone: _________________________ Today’s Date: __________________________________
Course Name: _____________________________________________
Course Number: ___________________________________________
Instructor Name: ___________________________________________
Instructor’s Campus Address: _________________________________
Instructor’s Phone Number: ___________________________________
Disability Services Handbook 27
Date of Exam: ______________________________________________
Approved Accommodations: ___________________________________
If you have questions about the office or the process for requesting accommodations, please contact the Disability
Services Office at 402-375-7496. This form and all other information may be submitted in person or through one of
the addresses below.
Fax:
402-375-7079
Mail: Disability Services
Wayne State College
1111 Main Street
Wayne, NE 68787
E-mail: [email protected]
Wayne State College Disability Services Interpreter Service Request Form
Holland Academic Success Center, Library 232, 402-375-7496
This form is your opportunity to describe your disability and accommodations you hope to receive. You may
supplement this form with additional information describing your disability and requested accommodations. (Please
attach additional paper.) You may want to include information about experiences related to your disability, barriers
you faced, and/or previous accommodations (effective or ineffective).
Student Contact Information:
Full Name: _______________________________________________________________________________
Student Identification #: ______________________________ Birthdate: ____________________________
WSC Email Address________________________________________________________________________
Student’s Phone Number(s):_________________________________________________________________ (Home) (Mobile) (Work)
Local Address: ____________________________________________________________________________ (Street) (City) (State)
Permanent Address: _______________________________________________________________________
Emergency Contact: _______________________________________________________________________
Disability Services Handbook 28
(Name) (Relationship) (Phone #)
Year/Term for which you are requesting services: _________________________________________________
Disability Information:
What is your disability or disabilities? __________________________________________________________
________________________________________________________________________________________
In your own words, please describe your disability.________________________________________________
________________________________________________________________________________________
Are you submitting other information or documentation with this form? Yes ___ No___
Potential Accommodations/Adjustments:
What accommodations/services do you hope to receive? ___________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
(Page 1 of 2)
What accommodations/services/assistive technology have you used in the past? ________________________
________________________________________________________________________________________
________________________________________________________________________________________
Are you currently affiliated with any of the following campus offices or programs?
o Student Health o TRIO Student Support Services
o Other
Do you receive services from any of the following agencies?
o Vocational Rehabilitation
o Other (e.g. audiologist) _____________ _________________________________________________
Referral Information:
Who referred you to our office? ______________________________________________________________
________________________________________________________________________________________
Additional Documentation:
Additional documentation should be submitted with this form and can include assessments, reports, and/or letters
from qualified evaluators, professionals, or institutions. Common sources of documentation are health care
Disability Services Handbook 29
providers, psychologists, diagnosticians, and/or information from a previous school (e.g., accommodation
agreements/letters, 504, IEP, or other relevant documents). Students are encouraged to submit other disability
related documentation that will help Disability Services better understand their needs. For more information
please refer to the Documentation Guidelines available on the Disability Services website,
https://www.wsc.edu/info/20177/holland_academic_success_center/81/disability_services
Submitting Information:
Disability Services will consider all relevant information submitted by the student. If you have questions about the
office or the process for requesting accommodations, please contact Disability Services at (402) 37-7496. This form
and all other information may be submitted in person, faxed to 402-375-7079 or sent via mail to [email protected]
Comments: ______________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
I certify that all information I have provided is true and accurate to the best of my knowledge. I understand that
intentionally providing false or misleading information may result in my being ineligible for services and may also
result in disciplinary action by Judicial Affairs.
______________________________________________ _________________________________________
Signature of Student Date
(Page 2 of 2)
Wayne State College Disabilities Services Exam Accommodation Request Form
Holland Academic Success Center, Library 232, 402-375-7496
An academic accommodation or modification is sometimes needed to ensure that a qualified student with a disability has an equal opportunity to access and benefit from a course or educational activity. EXAM ACCOMMODATION is a service provided to faculty members and students. Upon the request of the student and the faculty member, the Holland Academic Success Center will provide approved exam accommodations or modifications for WSC students with disabilities. Accommodations may include extended time limit, low-distraction exam area, enlarged print, exam reader or scribe, word processing, etc. If you have questions regarding disability-related exam accommodations, please call the Holland Center at 402-375-7496. Form can be completed online – or printed and completed by hand – then signed and returned to the Holland Academic Success Center when done.
------------------------------------------------To be completed by Student/Instructor ------------------------------------ Complete
information below and return to the Disability Support Services:
Student Name: ________________________________ Student Phone: _______________________
Course Title: __________________________________ Course #: ____________________________
Instructor Name: ______________________________ Instructor Phone: ______________________
Disability Services Handbook 30
EXAM TIMES: Holland Academic Success Center: Monday – Friday, 8am to 5pm by appointment.
ALL CHANGES AND EXCEPTIONS MUST BE INITIALED BY INSTRUCTOR
List specific date(s) below Instructor Initials
EXAM 1
EXAM 2
EXAM 3
EXAM 4
EXAM 5
_________________________ _________________________ _________________ Student Signature Instructor Signature Date
-----------------------------------------To be completed by Disability Support Services -----------------------------------------
APPROVED ACCOMMODATIONS:
o Individual Room
o Extended Time o
Reader o Scribe
o Word Processing o
Dictionary/Spelling List o
Calculator
o Other:
________________
Exam to Counseling Center o Delivered to Disability Support Services by Instructor o
Delivered to Disability Support Services by student (delivered in sealed envelope) o E-
mailed to [email protected]
Completed Exam to Instructor o Pick up Disability Support Services by Instructor o
Returned by student (in sealed envelope) to: _______________________________
Wayne State College Disability Services
Resource Guide to Campus Programs Holland Academic Success Center, Library 232, 402-375-7496
Counseling Center – Personal Counseling, Career Planning, International Student Advisor, Alcohol and Other Drug Counseling and Education, Violence Prevention. http://www.wsc.edu/counseling_center/ Located in the Student Center, Room 103 and at 402-375-7321.
Career Services – Resume Assistance, Internships, On-campus Interviews and Job Postings in CatTracks. http://www.wsc.edu/career_services/ Located in the Student Center, Room 101 and at 402-375-7425.
Residence Life – On-Campus Housing, Food Service Contracts. http://www.wsc.edu/residence_life/ Located in the Student Center 201 and at 402-375-7318.
TRIO Student Support Services – A Federally Funded Trio Program for qualifying students. Students must apply. Eligibility requirements are on the website. http://www.wsc.edu/triosss/ Located in the Student Center 12 and at 402-375-7500.
Holland Academic Success Center - Early Alert Program, Peer Tutors, Writing Help Desk, Academic Coaching,
Freshman Experience classes, Disability Support Services, Advising Center http://www.wsc.edu/hasc/ Located in
the Library, Room 232 and at 402-375-7496.
Multicultural Affairs – Mentoring, Leadership Development, Diversity Programs, Multicultural Groups. http://www.wsc.edu/multicultural_center/ Located in the Student Center 10 and at 402-375-7749.
Student Activities – Intramurals, Student Activities Board, Clubs and Organizations.
http://www.wsc.edu/student_activities/ Located in the Student Center and at 402-375-7322.
Campus Map - WSC Campus is accessible. http://www.wsc.edu/about/map/