Disability Support Services Registration Form

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Student Information

Please enter your information

First NameRequired *

Last NameRequired *

Preferred Name

Lehigh Student ID Number (LIN)Required *

Lehigh University Email (username@lehigh.edu)Required *

Please use your university issued email address

Personal Email AddressRequired *

Phone NumberRequired *

Please select your class standing:Required *

My diagnosed disability falls into the following categoryRequired *

Directions:

Directions: Please note, this form can be used to request academic, housing/dietary, transportation, and parking accommodations. Please complete all applicable sections.

Academic Accommodations

Are you requesting Academic Accommodations?Required *

Are you requesting Academic Accommodations? Yes Are you requesting Academic Accommodations? No

Are you requesting extended time for testing?Required *

Are you requesting extended time for testing? Yes Are you requesting extended time for testing? No

What disability related barriers prevent you from taking exams using standard administration time?Required *

Have you previously had an extended time accommodation in high school or college?Required *

Have you previously had an extended time accommodation in high school or college? Yes Have you previously had an extended time accommodation in high school or college? No

How much extra time did you receive?Required *

In what classes did you use extended time for testing? Was extended time needed for exams across all subject areas?Required *

How often did you need to use extended time?Required *

Why not? Why do you feel that you need extended time for testing at the university level when you haven't had it before?Required *

Did you receive extended time on SAT/ACT or GRE?

Did you receive extended time on SAT/ACT or GRE? Yes Did you receive extended time on SAT/ACT or GRE? No

More information regarding extended time for testing

Please include any other information you would like the Disability Support Services (DSS) review team to consider with regard to extended time for testing.

Are you requesting:Required *

Are you requesting: 1.5x extended time Are you requesting: 2.0x extended time

Please explain why 1.5x is not or has not been sufficient:Required *

Are you requesting Distraction Reduced or Alternate Testing Location?Required *

Are you requesting Distraction Reduced or Alternate Testing Location? Yes Are you requesting Distraction Reduced or Alternate Testing Location? No

Have you previously had a distraction-reduced or alternate location accommodation?Required *

Have you previously had a distraction-reduced or alternate location accommodation? Yes Have you previously had a distraction-reduced or alternate location accommodation? No

Please explain why you tested outside the classroomRequired *

Did you test in an alternative setting (such as a resource room) because of logistical/scheduling reasons (ie: you needed extra time that your classroom teacher could not provide in class, or because of disability-related barriers caused by testing in the larger classroom?

If disability related barriers prevented you from taking exams in the classroom with peers, please explain.

In what classes did you use this accommodation? Was it needed across all subject areas?Required *

Why not? Why is this accommodation now necessary at the university level when you have not had it before?Required *

Have you successfully used alternative strategies (strategic self-seating, noise-reduction headphones, etc)? Explain.Required *

Did you use an alternative testing setting for the SAT/ACT or GRE?Required *

Did you use an alternative testing setting for the SAT/ACT or GRE? Yes Did you use an alternative testing setting for the SAT/ACT or GRE? No

More information regarding alternative setting for testing

Please include any other information you would like the DSS review team to consider with regard to an alternative setting for testing.

If also requesting extended time for testing:

Please explain why an alternative setting is necessary in conjunction with extended time in order to ameliorate your barriers.

Are you requesting Note-taking Technology?Required *

Are you requesting Note-taking Technology? Yes Are you requesting Note-taking Technology? No

Have you previously had a note-taking accommodation?Required *

Have you previously had a note-taking accommodation? Yes Have you previously had a note-taking accommodation? No

What type of note-taking accommodation did you have?Required *

What disability-related barriers prevent you from effectively taking class notes?Required *

Please include in your response:

What happens when you try to take notes without this accommodation?

In what classes did you use the accommodation? Was it needed across all subjects?Required *

Why not? Why do you feel that you now need note-taking technology at the university level when you haven't had it before?Required *

How did you typically take notes in high school?Required *

ie: paper and pencil, laptop, use of note-taking technology or app, photos of board, etc.

What strategies have been helpful to you with taking notes in class?

More information regarding note-taking technology

Please include any other information you would like the DSS review team to consider with regard note-taking technology.

What type of note-taking technology are you requesting?Required *

Check all that apply.

Use of a laptop or tablet to type notes Permission to take photos of material on the board Audio recording using own device GLEAN Note-taking platform

Are you requesting other accommodations?Required *

Are you requesting other accommodations? Yes Are you requesting other accommodations? No

What accommodation(s) are you requesting?Required *

Have you previously been approved for these accommodations in high school or college?Required *

Have you previously been approved for these accommodations in high school or college? Yes Have you previously been approved for these accommodations in high school or college? No

Why do you believe these accommodations are now necessary?Required *

Expedited Approval ProcessRequired *

Occasionally, DSS may approve accommodations through an expedited process. If approved through this process, would you want academic accommodations to be applied to all courses in the coming semester?

Expedited Approval Process Yes Expedited Approval Process No

Semester for which accommodation is sought:Required *

Housing Accommodations

Are you requesting housing/dietary accommodations?Required *

Are you requesting housing/dietary accommodations? Yes Are you requesting housing/dietary accommodations? No

Disability Housing Accommodations Information

Due to high demand for on-campus housing, it is vital that students requesting housing accommodations comply with all application deadlines. While applications for disability housing/dietary accommodations will be accepted and considered after the deadline, approved accommodations for requests submitted after a deadline will be subject to housing availability.

Students requesting housing accommodations that are dietary in nature, including requests for kitchen facilities or meal plan modifications, are required to meet with the University dietitian as part of the interactive process. Consultations with the University dietitian can be scheduled online and should be completed in advance of the housing accommodation deadline.

Requests for no carpeting and/or air conditioning that are not linked to other housing accommodations are handled directly by Housing Services and not by DSS. Refer to the Air Conditioner Policy in Residence Halls for more information and a link to the Air Conditioning Medical Form to be completed by the student’s clinician.

Current Room Assignment (if applicable):

Semester for which the accommodation is sought:Required *

Year for which the accommodation is sought

Is this request due to a temporary injury?Required *

Is this request due to a temporary injury? Yes Is this request due to a temporary injury? No

Please indicate expected duration:Required *

Have you previously applied for disability accommodations?Required *

Have you previously applied for disability accommodations? Yes Have you previously applied for disability accommodations? No

When did you receive accommodations previously, and what were the accommodations you received?Required *

Please list the specific housing accommodation(s) you are requestingRequired *

For each, explain the disability-related rationale — how the accommodation is necessary to address the impact of your disability in the residential environment.

Example:

Requested Accommodation: Strobe fire alarm and bed shaker alarm
Disability-Related Rationale: I have a hearing impairment and am unable to hear standard auditory alarms, especially while sleeping. A strobe alarm ensures I am alerted during the day, and a bed shaker is necessary to wake me and alert me to emergencies during the night.

Transportation Accommodations

Are you requesting transportation accommodations?Required *

Are you requesting transportation accommodations? Yes Are you requesting transportation accommodations? No

Transportation Accommodations Information

Please visit the Parking and Transportation Accommodations Information page to learn more about requesting Parking Accommodations.

For which semester are you requesting transportation accommodations?Required *

Is this request due to a temporary injury?Required *

Is this request due to a temporary injury? Yes Is this request due to a temporary injury? No

Expected duration:Required *

Are you having difficulty using the Lehigh transportation system?Required *

Are you having difficulty using the Lehigh transportation system? Yes Are you having difficulty using the Lehigh transportation system? No

Describe the difficulty or barrierRequired *

Are you able to walk?Required *

Are you able to walk? Yes Are you able to walk? No

What is the maximum distance you can reasonably be expected to walk?Required *

Do you use a wheelchair or scooter?

Do you use a wheelchair or scooter? Yes Do you use a wheelchair or scooter? No

Can you climb stairs?Required *

Can you climb stairs? Yes Can you climb stairs? No

Please explain: Required *

What are the specific transportation accommodation(s) you are requesting?Required *

Describe the specific transportation accommodation(s) you are requesting and explain the disability-related rationale for each. Be as specific as possible and describe how the accommodation will address disability-related barriers in navigating campus and utilizing the ADA accessible bus system.

Example:

Request: Accessible point-to-point transportation between campus buildings
Rationale: Due to my disability, I cannot walk long distances or wait for extended periods. The campus buses do not stop close enough to my classes and require walking and waiting outdoors, which I am unable to do consistently due to my symptoms.

Parking Accommodations

Are you requesting parking accommodations?Required *

Are you requesting parking accommodations? Yes Are you requesting parking accommodations? No

Parking Accommodations Information

Please visit the Parking and Transportation Accommodations Information page to learn more about requesting Parking Accommodations.

For which semester are you requesting parking accommodations?Required *

Is this parking request due to a temporary injury?Required *

Is this parking request due to a temporary injury? Yes Is this parking request due to a temporary injury? No

Expected durationRequired *

Have you had any parking accommodations in the past for this same limitation?Required *

Have you had any parking accommodations in the past for this same limitation? Yes Have you had any parking accommodations in the past for this same limitation? No

What were your previous accommodations and how effective were they?Required *

Please describe the specific parking accommodation(s) you are requesting and explain the disability-related rationaleRequired *

For parking needs related to off-campus appointments, please be sure to provide verification from clinician of appointment schedule.

Example:

Request: Parking pass accommodation to have reliable access to my car on campus.
Rationale: I attend bi-weekly in-person therapy sessions off campus, which are a critical part of my ongoing mental health treatment plan.

Do you currently park on campus?Required *

Do you currently park on campus? Yes Do you currently park on campus? No

Please describe where you currently park.Required *

Do you have a state-issued disability parking permit?Required *

Do you have a state-issued disability parking permit? Yes Do you have a state-issued disability parking permit? No

Can you wait for a bus at a bus stop, parking garage, etc.?Required *

Can you wait for a bus at a bus stop, parking garage, etc.? Yes Can you wait for a bus at a bus stop, parking garage, etc.? No

Please explain.Required *

Can you ride a bus?Required *

Can you ride a bus? Yes Can you ride a bus? No

Please explain.Required *

Do you use a wheelchair or scooter?Required *

Do you use a wheelchair or scooter? Yes Do you use a wheelchair or scooter? No

Are you able to walk?Required *

Are you able to walk? Yes Are you able to walk? No

What is the maximum distance you can reasonably be expected to walk?Required *

Can you climb stairs?Required *

Can you climb stairs? Yes Can you climb stairs? No

Please explain.Required *

Documentation

Lehigh Documentation Guidelines

Please note that you are required to submit documentation to support your accommodation requests. Choose this link to access Lehigh University's documentation guidelines.

Upload supporting document(s)

Disability Support Services Registration Form

Student Information

Academic Accommodations

Housing Accommodations

Transportation Accommodations

Parking Accommodations

Documentation

Document Information