CSD Accommodation Request Form

COMPLETE ONLY IF CLAIMING AN ACCOMMODATION FOR A DISABILITY
PLEASE READ CAREFULLY
* indicates a required field

If you have a disability and believe you are entitled to any accommodations listed below AND you are certain that you want to use them, YOU ARE REQUIRED TO:

1. Complete this form.
2. Provide complete documentation of the disability.  See requirements below. If you don’t have your documentation, obtain it from your school, licensed psychologist or physician.

Entering SemesterRequired

Specific Accommodation Information

Are you affiliated with either of the New York State Agencies? Required
Are you affiliated with either NCC program?Required
Which accommodations are you requesting

Any items that are checked must be supported by documentation or they will not be provided.

THIS INCLUDES THE PLACEMENT TEST.  Upon review, we will contact you regarding accommodations

Upload supporting document(s)Required

Disability Documentation Requirements

The following documentation is requested for the disability indicated. Please call the Center for Students with Disabilities, (516) 572-7241 if you have any questions.

Learning Disability (LD) - Documentation must include Aptitude Test scores, including Subtest scores, and should be administered within the previous three years. The Wechsler Adult Intelligence Scale is the preferred aptitude test. The Kaufman Brief Intelligence Test is not accepted. Documentation must also include Achievement Test scores,  and should be administered within the previous three years. The Woodcock-Johnson Test of Achievement is preferred. Woodcock-Johnson Cognitive scores are helpful, but not required.

Other Health Impaired (OHI) - OHI covers a range of disabilities, including ADD, ADHD, Autism Spectrum and more. The specific disability within OHI must be identified. Documentation must come from the professional who diagnosed the disability, usually a licensed psychologist or medical doctor and it should be diagnosed or reconfirmed within the previous three years. The IEP may not meet this requirement.

Emotional Disability - The disability must be identified with the specific DSM 5 diagnosis made by a licensed medical doctor, psychologist or other qualified health professional. The disability should be diagnosed or reconfirmed within the previous three years.

Hearing Disability - Documentation must be provided by a licensed otolaryngologist, otologist or audiologist and include an audiogram.

Visual Disability - Documentation must be provided by a licensed ophthalmologist, optometrist or other appropriate medical specialist for visual impairment. 

Physical Disability - Documentation must be provided by a licensed medical doctor or other qualified health professional.