Disability Services Application

Please Read Completely

In order to receive academic accommodations during your attendance at New Mexico Highlands University you must supply appropriate clinical documentation of your disability. In evaluating your documentation, Highlands has adopted standards utilized by Association of Higher Education and Disability (AHEAD) member institutions. Failure to supply appropriate medical documentation will result in your application for services be denied. Please note that high school IEP’s alone are never sufficient to document a disability.

All students must submit the attached Medical Certification form, completed by an appropriate and qualified health care services provider.

For students with Learning Disabilities, the Medical Certification form must be accompanied by a full diagnostic evaluation completed by a licensed neuro-psychologist or psychologist trained in the assessment of learning disabilities. This evaluation must have occurred within the last three years and must clearly state that (a) a learning disability exists. (b) the nature of the learning disability, (c) the test utilized to diagnosis the learning disability and (d) accommodations required.

For students with psychological, emotional, and psychiatric disabilities, the Medical Certification form must be accompanied by an evaluation by a licensed psychologist or psychiatrist based on the current DSM manual. The evaluation must have occurred within the last year and clearly indicate (a) the DSM code for disability (b) the severity and length of the disability, (c) the current course of the treatment, (d) any medication prescribed, and (e) accommodations required.

For students with physical disabilities, a diagnosis from the current ICD from a physician is required. For students with audio disabilities, this form must be accompanied by a current audiogram from an ENT or Audiologist.

Before completing this form, please answer the following question:

Do you have a digital/electronic copy of your documented disability from a healthcare provider as described above?

Prior to completing this form, please acquire documentation of your disability from a healthcare provider by providing the linked form below to your provider and then uploading a digital/electronic copy to this application.

Disability Documentation Form

Healthcare Provider Documentation

Please upload your documentation here:

Application for Accommodations

In order to begin the process to receive accommodations based on a disability each student must submit the following paperwork (Additional paperwork may be required):

This form completed and submitted.
A signed and dated copy of the Release and Medical Information form.
Documentation of disability consistent with the requirements outlined in the attached handout entitled “Disability Documentation Requirements.”

I am requesting accommodations at New Mexico Highlands University because I have a disability as defined by the Americans with Disabilities Act (ADA) and/or Section 504 of the Vocational Rehabilitation Act and/or the ADA Amendment Act of 2008.

I understand that it is my responsibility to follow the procedures of ACCESS and supply all the necessary paperwork to document the presence of my disability.

I understand that professors are not required to supply accommodations retroactively.

I understand it is my responsibility to notify ACCESS prior to the beginning of each semester that accommodations will be needed and I will provide all necessary course information, including instructor(s) full names.

I understand that no accommodations will be made until all documentations have been received by ACCESS and instructors have been notified of approved accommodations.

Accommodations Student In-Take Form

Today's Date

Banner ID/Student ID

Please identify your student level

Birthday

First Name

Last Name

NMHU Student Email

Phone Number

Address

Country

Street

City

Region

Postal Code

Sex

If you would like the opportunity, we invite you to share more about your gender identity.

I am requesting accommodations at New Mexico Highlands University because I believe that I have a disability, as defined by the Americans with Disabilities Act (ADA) and/or Section 504 of the Vocational Rehabilitation Act and/or the ADA Amendments Act of 2008. By signing this form I am aware of the following policy and procedures of NMHU and that these must be followed for me to receive an accommodation.

No accommodations will be provided until I have turned in all necessary documentation and all instructors have been notified.

The Documentation of Disability Form must be filled out completely before any accommodations can be made. Similar documentation from healthcare providers may also be acceptable.

I acknowledge that additional documentation may be required on a case-by-case basis in order for ACCESS to appropriately evaluate my request for accommodations. I agree to provide this documentation in a timely manner. I further understand that NMHU may require that I be examined by a health services provider of its choice, at its expense, before providing the accommodation.

I understand that, if I have a disability I must be otherwise qualified to participate as a student at NMHU, as those terms are defined under the ADA and/or Section 504 of the Vocational Rehabilitation Act and/or the ADA Amendment Act of 2008. NMHU is required to provide me with a reasonable accommodation of my disability, but not necessarily the accommodation that I request. These accommodations will be determined by an interactive process with the coordinator of disability services.

I need to submit a class schedule that includes course name and number, CRN number, and full name of instructor before the University’s add/drop deadline for each semester. All instructors must be notified of accommodations on a timely basis.

All my information be treated confidentially by the university. I am responsible for informing my professors of the accommodation approved for me if I want the professors to be aware of it. ACCESS will not automatically do so on my behalf.

If I have any disagreement with a decision by ACCESS, I can appeal that decision to the VP of Academic Affairs.