Western Accommodation Intake Form

* indicates a required field

Introduction

AccessAbility Services at Western Connecticut State University is committed to providing accommodations and support services to students with disabilities in order to ensure a comprehensively accessible University experience. AAS engages in an interactive process with each student and review requests for accommodations on a case-by-case basis. In determining reasonable accommodations, we consider each student's condition(s), history, experience, request, and the unique characteristics of each course and program.

Students interested in registering with AccessAbility Services (AAS) for the first time to request accommodations should complete this form and submit any supporting medical documentation regarding their disability. If you have previously requested accommodations through this form, and want to view your request and associated materials, you should log into WCSU Accommodate Portal.

Please read all instructions carefully prior to completing this form.

Documentation:

While students are a vital source of information, in order to determine reasonable and appropriate accommodations, AAS may request information from other sources in order to establish a disability and the impact it has on living and/or learning in a postsecondary environment. It is recommended that you submit documentation of your disability which is consistent with AccessAbility Services established documentation guidelines. Please visit AccessAbility Services Documentation Guidelines webpage to learn more.

Accommodation Process:

After filling out this form, you will receive an email instructing you to schedule an intake meeting to discuss your request. In addition, you will be instructed to sign and upload an Authorization for Request or Release of Information to WCSU Accommodate Portal. AAS engages in an interactive process with each student and reviews requests for accommodations on an individualized, case-by-case basis.  Appropriate academic services and accommodations are provided based on a student's functional limitations in the academic setting.  When scheduling an intake meeting, please indicate if you will require any accommodations for the meeting; such as, captioning, interpreting, large print, and/or information about accessible parking.

Please note the following:

  • AccessAbility Services (AAS) is the University agent charged with the responsibility for collecting and maintaining documentation related to students’ conditions.
  • Documentation provided to AAS is confidential and only shared with others with the expressed written permission of the student, except in the case of a compelling reason, such as a threat to an individual’s safety and/or an emergency situation.
  • Consent of the student will be requested prior to releasing documentation to a third party. Confidentiality is not maintained in the case of child abuse, suicidal or homicidal intent.
  • All documents submitted to AAS are maintained in a confidential electronic case management system, including information about student demographics, academic programs, documentation of the condition(s), accommodations, and student contacts with AAS.
  • AAS' electronic case management system is hosted on a secure server and is developed and maintained using industry best practices. AAS' electronic system does not share information with other databases throughout the University (e.g., Banner, etc.).
  • Any documents provided to AAS in paper form are scanned, uploaded to the electronic case management system, and then shredded immediately.
  • Access to the electronic case management system is limited to authorized AAS personnel only.
  • Once a student no longer has contact with AAS (e.g., graduates, leaves the University, etc.), student files are securely stored and destroyed in accordance with the State of Connecticut’s Records Retention and Disposition schedule.
Student Information
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Your WCSU email address is the official form of communication for WCSU.
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Class Standing(Required) *






Are you a transfer student?
Are you a commuter student?
Are you a University Athlete?
Are you a Military Veteran?
Are you an EAP student?
Are you an Honor's Student?
Are you part of Greek Life?

Accommodation Information

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Did you receive any academic assistance in high school?
Are you a client of the Bureau of Rehabilitation Services (BRS)?
Are you receiving services from an area community resource (e.g., DMHAS, DCF, etc.)?
Are you receiving services from other professionals in the community (e.g., therapy, counseling, tutoring, etc.)?
Are you receiving services or have you received sercives from an on-campus service (e.g., Counseling Center, CHOICES, Tutoring Resource Center, etc.)?

While you are a vital source of information, AAS may request information from other sources in order to establish a disability and the impact it has on living and/or learning in a postsecondary environment. If you have documentation regarding your disability, please upload it now. If not, you will be able to upload your documentation later. If you have questions about what type of documentation may be needed, please visit AccessAbility Services Documentation Guidelines webpage. Students who need assistance scanning and uploading documents may visit AccessAbility Services located in White Hall 005.