Disability Accommodation Request Form
Cameron University is committed to meeting the needs of students with disabilities based upon
documentation of a disability covered under the Americans with Disabilities Act Amendments Act
(ADAAA) of 2008 and Section 504 of the Rehabilitation Act of 1973, as amended. It is the
university's philosophy that students with a disability must have equal educational opportunities. Our
office can provide the following services and support:
• Facilitate access for academic services to disabled students
• Coordinate any special classroom needs for the student
• Interact with faculty if a student has a problem in class or needs information or referrals to other
departments or agencies
Do I Qualify?
The federal definition of a disability includes a person who (1) has a physical or mental impairment
which substantially limits one or more of such person's major life activities; (2) has a record of such
impairment; or (3) is regarded as having such impairment. The student must provide documentation
of an impairment which shows that the impairment restricts the ability to perform a major life activity
in comparison to the average person in the general population.
How Can I Access Disability Services?
In order to access disability services at Cameron University, you must register with the Office of
Student Development. Registration is accomplished by taking the following steps:
• Self-Identify as a student with a disability and complete a Request for Accommodations form
through our office. The form is available at North Shepler, Room 314 or online at http://
www.cameron.edu/disability_services. Along with the form, please submit documentation verifying
the presence and current functional impact of the disability.
• Once your documentation is received, it will be reviewed (you will be notified if additional
documentation is needed). You will then meet with a staff member to discuss the accommodations
process and your rights and responsibilities in postsecondary education. This process is interactive
and your input on previous or current educational experiences and accommodations is helpful. The
University is not obligated to waive or substitute anything that is fundamental to the nature of a
program.
What Type of Documentation is Needed?
Please provide appropriate documentation from a qualified physician/diagnostician to the Office of
Student Development verifying the presence and functional impact of the disability. The type of
documentation will vary according to the disability but should give us a basic understanding of what
your disability is and how the disability impacts you in the classroom environment. Recent
documentation is recommended, but older documentation for chronic, non-progressive disabilities
may be accepted in some cases. Disabilities with symptoms or features that tend to change over
time may warrant more frequent updates in order to provide an ongoing and accurate picture of
your needs. The Office of Student Development reserves the right to deny services or
accommodations until appropriate documentation has been received. The documentation should
address the following:
• Credentials of the evaluator(s):
Documentation must be provided by a licensed or otherwise properly credentialed professional who
has undergone appropriate training, has relevant experience, and has no personal relationship with
the individual being evaluated. There should be a match between the credentials of the individual
making the diagnosis and the condition being reported (e.g. an orthopedic disability documented by
a physician but not a licensed psychologist). The documentation of a disability should be provided
on the letterhead of either the practitioner or the agency hosting the practice.
• Diagnostic statement identifying the disability:
Documentation must include a clear statement of the specific diagnosis of each disability.
Documentation should include evaluation methods and tests and dates of administration, along with
specific results.
• Current functional limitations associated with the disability:
Documentation must include information on how the disability currently impacts the student's major
life activities. Some examples of major life activities are walking, hearing, seeing, concentrating,
mental status, major bodily functions, and the ability to perform manual tasks. A statement on the
severity, frequency, and pervasiveness of the condition should be included. If applicable, the
documentation also should include a description of current medications or services used to treat the
condition.
• Specific recommendations on accommodations
Documentation may include specific recommendations as to the types of reasonable
accommodations needed (e.g. extra time for testing, note taking assistance). It should clearly
describe the relationship between the disability and how an accommodation would provide access.
The University has no obligation to provide or adopt recommendations but will consider them in
order to provide equal access to education.
How can I get more information about Disability Services?
For more information, contact the Office of Student Development at (580) 581-2209, e-mail us at
student_development@cameron.edu or stop by our office in North Shepler Room 314. Additional
information can also be found at http://www.cameron.edu/disability_services.
The Office of Student Development does NOT evaluate requests for employment accommodations.
Cameron University employees, including student workers, must contact the Human Resource
office to request employment accommodations.
Request For Accommodations
Cameron University Disability Services
Name
Cameron ID #
Mailing Address
City
State
Phone Number
Zip Code
CU Email Address
1) Which semester are you requesting accommodations to start?
2) What is/are your disability/disabilities?
3) How does/do your disability/disabilities affect you as a student?
4) What accommodations are you requesting?
RELEASE OF INFORMATION
(General Release and Letters to Instructors)
It may be necessary for the Office of Student Development at Cameron University to communicate
with your instructors, certain campus offices (Physical Facilities, Testing, etc.), and/or your
physician/diagnostician in order to provide the appropriate accommodations. This can be done only
by permission of the student.
I, hereby authorize Cameron University, Office of Student Development, to use information
contained in my personal records to evaluate my disability as it relates to programs and services
that could accommodate me as a student.
Once a determination has been made, I further authorize the Office of Student Development to
provide letters of accommodations to my instructors based on this determination. I understand that
specific information about my disability cannot and will not be released to my instructors or other
persons. I would like accommodation letters sent to my instructor:
Yes
No
Signature
Date