DISABILITY SERVICES
Dear Endicott Student;
The Division of Academic Resources provides a variety of services to all students on campus that
include: the Advising Services Center, Disability Services, Tutoring Center, Licensure Examination
Preparation, Student Support Center, and the Writing Center. We are open Sunday through Friday with
day and evening hours available. We encourage you to seek out our services and look forward to seeing
you next semester.
We provide services and academic accommodations to students with disabilities in accordance with the
1993 Rehabilitation Act, the Americans with Disabilities Act of 1990, and the ADA Amendments Act of
2008. In order to be successful at Endicott, students are strongly encouraged to register with Disability
Services regarding any documented disability, regardless if you are seeking accommodations at this time.
Students who self-identify must verify their disability with supporting documentation performed by a
qualified professional. Proper documentation includes:
 Neuro-psychological or educational diagnostic evaluation;
 High School 504 or Individual Education Plan (IEP);
 Current listing of medication; and
 Any other relevant educational or medical information that supports your request for
accommodation.
Additionally, Disability Services works closely with the Counseling Center to facilitate healthy living of
our students as well as the Athletic Department regarding NCAA athlete compliance regarding banned
substances.
It is the responsibility of the student requesting accommodations to present documentation and request
accommodations prior to the beginning of each academic semester. Eligibility for reasonable and
appropriate accommodations will be determined on an individual basis. Please note that services cannot
begin until a completed application is on file with the Disability Services Office.
We look forward to working with you this semester. Please direct all questions regarding
accommodations and appropriate documentation requirements to Disabilities Services. Please complete
this form and return to:
Endicott College
Division of Academic Resources
Disability Services Office: Library 205
376 Hale Street, Beverly, MA 01915
disability@endicott.edu
Phone: 978-998-7746
Fax: 978-232-2150
Request for Disability Accommodation
Name: __________________________________ DOB: ___________
Endicott Student ID# ____________
Home Address:____________________________________________________________________________
Town/City______________________________ State _______________________Zip Code_______________
Major ______________________Home Phone: ___________________ Cell Phone: _____________________
Endicott Email address: __________________________ Home Email address: __________________________
Current Class: (circle one) new incoming student* freshmen * sophomore * junior * senior * graduate student
Campus (circle one) Beverly * Gloucester * Boston * Other:________________________
1. Briefly describe the nature of your disability including diagnosis.
2. On the checklist that follows indicate the accommodations related to your disability that you are requesting.
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Alternative media: ________________________________________________________
Dietary accommodation: ___________________________________________________
Disability housing: note room and board charges apply.
Note taking services
Testing (time & half) for examinations proctored at the Disability Services Office
Testing (with reduced distraction) for examinations proctored at the Disability Services Office
Other: __________________________________________________________________
3. Supporting documentation including a current medications list. Check all that apply:
____ I sent my documentation and medication listing during the admissions process.
____ I sent my documentation and medication listing to the Disability Services Office
____ I plan to send my documentation and medication listing to the Disability Services Office
4. Release of Information (please select one) I do ____ I do not _____ give permission to the Disability
Services Office to share any relevant information with my School Dean/Academic Advisor/Faculty/Student
Affairs Departments/International Office/Internship Coordinator /Athletics and/or other appropriate Endicott
staff regarding my disability following the ADA guidelines.
5. ADDITIONAL INFORMATION
_____I would like information regarding Endicott’s:
___ Counseling Center
_______________________
Student Signature
___ Student Support Center ___ Tutoring Center ___Writing Center
______________________
Date