Public Accommodation Request

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Student Information

Please enter your information
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CCUID
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Please use your Coastal Carolina University issued email address
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Gender Pronouns



Do you belong to any of the following groups/populations?










Education Classification




Specific Accommodation Information

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Type of Disability


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What type of accommodations requested?(Required) *




Is your Housing Accommodation Request for a Support Animal?
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If yes, please give as much information as possible. Please include detailed information about accommodations used on any standardized tests e.g. SAT/ ACT/GRE etc.
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By submitting this form, I acknowledge that (1) only I, the student or applicant, have filled out this form; (2) this application will not be processed until pertinent documentation of disability has also been provided; (3) Accessibility and Disability Services will consider the accommodations as requested on this form; (4) I authorize Accessibility and Disability Services and individuals providing information in my disability-related documentation to consult as part of the review process; (5) accommodations, if rendered, may not be the same as those received in high school or at another institution, and will not apply retroactively; (6) the accommodation determination process will take up to 14 days; (7) I, the student or applicant, have read and agreed to the Student Rights and Responsibilities.

 
Accessibility and Disability Services Rights and Responsibilities
Accessibility and Disability Services Rights and Responsibilities agreement(Required) *
 
ADS Documentation Guidelines and Registration Process

Coastal Carolina University, through Accessibility and Disability Services (ADS), provides services to students with diagnosed medical/physical disabilities in accordance with the Americans with Disabilities Act (ADA) of 1990, ADA Amendments Act 2008, and Section 504 of the Rehabilitation Act of 1973. To determine eligibility for services, this office requests current and comprehensive documentation of the disability or medical condition from the diagnosing physician or other appropriate professional.

This registration process is intended for use by incoming or current Coastal Carolina University students with a diagnosed disability. ADS recommends students submit the documentation discussed within these guidelines/process at least 14 calendar days prior to the start of the course or exam for which the student seeks accommodations. Please note that accommodations cannot be applied retroactively. Contact Accessibility and Disability Services with any questions regarding the following process:

 

1. Complete the Accessibility and Disability Services Self-Identification Form. By submission of this form you are also agreeing that you have read and understand the Rights and Responsibilities.

2. Submit documentation from a medical provider, or other qualified professional, regarding your disability or medical condition. The following information must be documented on the provider’s letterhead and must include the following:

a.   Diagnostic statement identifying the condition or disability.

b.   Date of the most current contact and date of the original diagnosis.

c.   Description of the diagnostic tests, methods and/or criteria used to diagnose the condition or disability.

d.   Description of the current symptoms and the substantial functional impact of the condition or disability on a major life activity (i.e. how does this condition affect the student’s learning, mobility, communicating, thinking, etc.).

e.   Treatments, medications, and/or assistive devices/services currently prescribed or in use, as well as any significant side effects of treatments or medications.

f.     Description of the expected progression or stability of the impact of the condition or disability over time, particularly, the next 5 years.

g.   Whether the condition or disability described is permanent, long-term (6-12 months), or short-term/temporary (6 months or less).

h.   Recommendations for accommodations, (e.g. extended time for exams, preferred seating, etc.).

i.     Name of provider/assessor, credentials/title and signature


3. Gather historical disability documentation, such as an Individual Education Plan (IEP), 504 Plan or accommodation letters from prior institutions of higher education.
 

4. Submit all of the above to Accessibility and Disability Services via encrypted email, mail, fax or in-person. Symplicity Note – ADS is hopeful that all of this information will be submitted via Symplicity when the student registers.

5. Contact Accessibility and Disability Services to schedule an initial accommodation set-up appointment. 

If documentation is not easily accessible, please complete this registration form and submit documentation at a later date. Documentation can be mailed, emailed, faxed, and hand-delivered to ADS. Please visit the ADS website for contact information. (Ex. IEP, 504 Plan, Psychoeducational Evaluation, Medical Diagnosis)