Denison University Academic Resource Center Accessibility Services Intake Form
Please complete this form in order to begin the process of registering with Accessibility Services at Denison University. Students (not parents or providers) should complete this Accessibility Services Intake Form and request that appropriate disability diagnostic documentation be submitted to the Academic Resource Center from an appropriate healthcare provider (more details about submission of documentation is at the end of this intake form). The intake application process is not considered complete and cannot be processed for review until this form AND the diagnostic documentation has been received.Thank you.
Email address *
Student's First Name *
Your answer
What is your preferred name? *
Your answer
Student's Last Name *
Your answer
Student's cell phone number *
Your answer
Student's Denison ID Number (if known)
Your answer
What are your preferred pronouns? (she/her/hers, he/him/his, they/them/their etc.
Student's Home Street Address *
Your answer
Student's Street Address line 2 (if needed)
Your answer
Student's City, State, and Zip Code/Postal Code *
Your answer
Student's Country of Residence *
Your answer
I am a . . . (check all that apply) *
Required
What is your intended major?
Your answer
If you are an incoming First Year Student, what June Orientation session are your attending?
Emergency Contact Name and connection (example: Debbie Denison, mother) *
Your answer
Emergency Contact's Phone number - (area code)555-5555 *
Your answer
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. https://denison.edu/academics/support/documentation-of-disability Check all that apply. *
Required
When was your disability first identified or diagnosed?
What is the approximate date of your most recent evaluation? (Month/Year)
Your answer
In as much detail as possible, please describe how the diagnosed disability impacts you as a student and/or in an educational setting. *
Your answer
What type of reasonable accommodations have been helpful to you in the past? *
Your answer
What type of reasonable accommodations do you anticipate requesting at Denison University? *
Your answer
Is there any other information you would like to share regarding your disability?
Your answer
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! An ARC staff member will be in touch to discuss your disability and possible academic accommodations. (currently appointments are via phone call or video chat)
Your answer
Documentation of Disability
Denison University requires a written report prepared by an appropriately licensed professional that clearly diagnoses a disability and/or provides records showing the history of the disability. Medical doctors, psychiatrists, psychologists, and school psychologists are among the professionals who routinely evaluate, diagnose, and treat disabilities. Evaluations must be current. As a guideline, Denison University generally requires documentation prepared within the past two to three years. The Academic Resource Center reserves the right to request an updated or more extensive evaluation. The written report must include a specific diagnosis, clear and specific evidence, and identification of a disability. Diagnostic reports must include the names and titles of the diagnostician as well as the date(s) of testing. Reports must be typed and otherwise legible. While an IEP or 504 Plan is helpful, it is not always adequate documentation of a disability unless it includes the specific diagnosis and recent testing data that documents the nature and severity of the disability.

For forms that can be given to your licensed professional (if needed) please see the Denison University website here: https://denison.edu/academics/support/forms.

You may submit your diagnostic evaluation via regular mail to Denison University, 100 West College Street, Academic Resource Center, 020 Higley Hall, , Granville, Ohio 43023; via email to the Academic Resource Center: arc@denison.edu; or via fax at 740-868-1168.

All documentation in the student's file is treated confidentially and will not be released to anyone not involved in the accommodation and service-delivery process without express written permission from the student. Information of this nature is not automatically shared with the Wellness Center in Whisler Hall, nor do they share information with the Academic Resource Center without the written permission of the student.
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