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Request for Disability Resources


Jacksonville State University provides reasonable accommodations to individuals with disabilities through the Disability Resources. Any Student who has a documented disability to such a degree as to interfere with or impede a major life activity can take advantage of the services provided by Disability Resources. The purpose of this request is to aid in planning and coordinating appropriate accommodations by identifying the specific needs of each student with a disability.

Background Information

The information contained in this request of services is not used in determining a student's eligibility for admission to Jacksonville State University. Application for admission to the University is a separate procedure.

 
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Select the section by the first letter of student's last name. (i.e. Smith would be Section 2)
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Requesting Student

Involved party 1

Additional Information

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Disability Information (Check all that apply)(Required)
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Have you received accommodations for this disability in the past?(Required)
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If yes, where did you receive these accommodations? (check all that apply)
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Did you receive services from Vocational Rehabilitation or some other office of rehabilitation services?(Required)
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If no, would you like assistance contacting VR for possible eligibility of vocational services?
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I understand the following: Jacksonville State University (JSU) is committed to providing reasonable accommodations to qualified students with disabilities. These accommodations are provided to assist students with disabilities in accessing education at JSU. Working in partnership with the student, the Disability Resources Case Manager will develop an Individual Postsecondary Plan (IPP) for accommodations. Please note that program requirements will not be altered and standards will not be lowered. I am responsible for submitting documentation to verify the presence of a disability and request services each semester.(Required)
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I agree to supply the requested documentation in order to verify my disability and receive accommodations at Jacksonville State University.(Required)
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I understand the following: Reasonable accommodations are not retroactive and effective from the date that the Individualized Postsecondary Plan (IPP) is presented to the appropriate university personnel.(Required)
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I understand the following grievance process: If I have a concern about my reasonable accommodations, I may contact Dr. Sean Creech, Director of Disability Resources, at screech@jsu.edu or (256) 782-5264. Dr. Creech’s Office is located on the 2nd floor of the Houston Cole Library. I may also contact Dr. Timothy B. King, Vice President for Student Success at tbking@jsu.edu or (256) 782-5020. Dr. King’s office is located on 1st floor of Houston Cole Library.(Required)
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Authorized Party. I understand the staff of the Office of Disability Resources at JSU will have access to records pertaining to my disability in addition to my academic records. I further understand that in order to meet my educational needs it may be necessary for Disability Resources to contact other campus departments and disclose personal information on an as needed basis. I authorize the Disability Resources staff to release/share information related to my disability and related reasonable accommodations to the following:(Required)
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Supporting Documentation

Supporting documents may include medical records, psychological evaluations, IEP, 504 Plan, or other school records, etc. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission