Request an Intake Appointment
Student ID Number
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First Name
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Last Name
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Preferred Pronoun
She/her/hers
He/him/his
They/them/their
Other
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Other Pronoun
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Please indicate your disability. Select all that apply and then provide the appropriate diagnostic documentation according to the documentation guidelines required for the area of disability.
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ADHD
Learning Disability
Mental Health Disability
Chronic Health/ Medical
Autism Spectrum Disorder
Traumatic Brain Injury (TBI)
Physical Disability/Mobility
Visual Impairment
Hearing Impairment
If Other, please discuss below.
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In as much detail as possible, please describe how the diagnosed disability impacts you as a student and/or in an educational setting.
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What type of reasonable accommodations have been helpful to you in the past?
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What type of reasonable accommodations do you believe will be helpful at Albion?
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ther than a class, is there anything else we can help you with?
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Please indicate an approximate date you plan to submit the required documentation of your disability. We recognize obtaining documentation may be more challenging during the pandemic and will work with you and your provider to secure this information. Thank you for your submission, and we look forward to meeting you! A staff member will be in touch to discuss your disability and possible academic accommodations. (currently, appointments are via phone call or video chat)
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