Public Accommodation Request

Accommodations Application

The Student Disability Support office works with current and incoming students with disabilities to ensure that opportunities exist for involvement in the full academic experience while in attendance at SUNY Upstate Medical University. Any student requesting accommodations should start by completing the Student Information section. Please provide as much information as possible which includes declaring the disability or suspected disability and requesting possible accommodations.

It is also the student’s responsibility to provide medical documentation to be reviewed by the Coordinator of Disability Support Services. Please visit the Getting Started/Intake/Procedure webpage and the documentation for information regarding our process and documentation.

We recommend that you connect with our office as early as possible to ensure that accommodations are in place since they are not retroactive. You may put in a request at any time as a student at Upstate and we welcome questions about our process.

Student ID

ex. "000123456"

Please use your university issued email address

Phone Number

Please list each specific disability and when you were professionally diagnosed

Example: ADHD: Summer 2012

Name of qualified professional who made diagnosis

Type of health care provider who made diagnosis

Current address and phone number of provider who made diagnosis

What treatment(s)/medication(s) have you pursued?

Provide the name and qualifications of the treating professional, the time fames in which you were treated, the impact of the treatment on your condition, and an explanation for why a treatment may have been discontinued .

Requested accommodation(s)

Please describe any previous accommodations you have requested during your educational career.

Please provide a description for any accommodations received for classroom exams or admissions tests

Documentation Upload

All disability documentation must meet the criteria described in the guidelines, and new evaluations should use the appropriate forms if possible. Please note that for certain disabilities (learning disabilities, ADHD, etc.) a formal evaluation should be submitted as well. If you are not currently connected with a physician or do not have documentation, next steps will be discussed at your initial intake meeting. We encourage students to complete the Student Information section and schedule a meeting even if the documentation is missing or incomplete.

If you have documentation of your disability and history of accommodations, please attach it below. You may also send documentation to the office of Disability Support Services via email, mail, or in-person:

Student Disability Support Services

SUNY Upstate Medical University

766 Irving Ave, Health Sciences Library 130

Syracuse, NY 13210

StuServe@Upstate.edu

(phone) 315-464-8855

(fax) 315-464-5431