Registration Form

* indicates a required field

Student Information

Current and incoming students are welcome to register with Student Accessibility Services if they are interested in accessing disability accommodations, exploring eligibility, or just identifying as a student with a disability. We encourage students to register as early as possible, but they are welcome to submit an application at any point during their time at the SUNY Brockport. To register with Student Accessibility Services and/or request disability accommodations, please complete the field below.
IMPORTANT: READ BEFORE CONTINUING

This is a legal document and can only be completed by the SUNY Brockport student themselves, parents/guardians completing this form will result in a deletion of the entire file due to compliance with legal regulations.

Must be 9 digits
Please use your @brockport.edu email address
Identity
The fields below are optional. The intent behind the acquisition of this data is to show the dynamic intersectionality of our beautiful disability minority group. It is our goal to honor all of the identities that make us unique individuals.

Specific Accommodation Information

Choose the earliest semester for which you are requesting accommodations and will be enrolled in courses.

A List of Conditions is available here if needed.

More information about disability-related accommodations is available. Noting items on this list does not necessarily guarantee their approval. Final determination will be made by the Accessibility Specialists of Student Accessibility Services.

Are you served by any of the following agencies?Required




If you selected any of the agencies above, please list your caseworker, phone number, and name of the agency here.

How did you hear about us and our services?Required
(check all that apply)
If you selected "other" above, please indicate how you heard about us and our services.
Documentation AgreementRequired

I understand that I am responsible for submitting current eligibility documentation specific to my disability(ies) as it pertains to the requested accommodations I have specified above. Upon receipt and approval of such documentation, services will be determined during a personal consultation with an Accessibility Specialist of Student Accessibility Services.

Consent AgreementRequired

Information Sharing & Record Maintenance

Disability documentation is maintained with confidentiality at SAS and is not part of your permanent educational record.  Documentation is protected under Family Educational Rights and Privacy Act (FERPA) and will be released from your file in the following circumstances only:

  1. Required under law
  2. Upon your request
  3. Within the accommodation implementation process for compelling and legitimate "educational need to know" circumstances

Disability-related information sharing will occur on a "need to know" basis, and only when there are compelling reasons for such disclosure. This may mean sharing only that a student has a documented disability and need for accommodation(s), or it may mean sharing pertinent information from the student’s file, as the situation dictates. If an implementation conversation must occur where disability-related information is shared, the student will be informed as to what information was provided to faculty or staff regarding the request.

In accordance with the SUNY Records Retention Policy, SAS students' files and records are destroyed six years after graduation or date of last attendance.

Attachments
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