Disability Services Survey

Name *

First Name Last Name

E-mail *

Phone Number *

Area Code Phone Number

VCFA Program *

Semester *

Vermont College of Fine Arts (VCFA) will, in accordance with Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and similar Vermont law, provide reasonable accommodations to students with documented disabilities in its educational and residential programs. The essential academic and graduation requirements of VCFA will remain identical for all students with or without disabilities, and VCFA will not provide accommodations that would fundamentally alter the nature of the College’s programs.

A disability covered by the laws referenced above is a physical or cognitive impairment (i.e., (A) any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological; musculoskeletal; special sense organs; respiratory, including speech organs; cardiovascular; reproductive, digestive, genito-urinary; hemic and lymphatic; skin; and endocrine; or (B) any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities) that substantially limits one or more major life activities. "Major life activities" means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

Vermont College of Fine Arts ADA Policy

Do you have a physical or mental impairment that substantially limits one or more major life activities, and for which you seek reasonable accommodations from VCFA? *

Yes No

If you checked “YES” above, please explain the nature of the impairment(s) for which you seek accommodation and what sort of accommodations or assistance you feel you may need.

Please note:

It is your responsibility to provide official documentation of a disability to the Accessibility Services Coordinator disability.services@vcfa.edu .

Documentation should be from an objective, qualified, licensed professional, and should consist of a comprehensive report, including diagnoses, a description of how the physical or mental impairment substantially limits one or more major life activities, and recommendations for academic or other accommodations. The report and documentation may be provided by the student when this DSS form is submitted, or it may be provided later in consultation with the Accessibility Services Coordinator. Even if some information is provided with the DSS form, the Accessibility Services Coordinator may request additional information, depending on the circumstances. All evaluations must be reasonably current, depending on the nature of the condition(s) at issue. VCFA does not conduct or pay for such assessments or for the preparation of related documentation.

My signature indicates that I have read the above and understand that it is my responsibility to provide documentation in a timely fashion if I wish to receive accommodations. I understand that these records will be maintained only by the Accessibility Services Coordinator to determine what services or accommodations may be required and will be kept confidential, subject to the terms explained in more detail in VCFA’s ADA Policy. *

Date *

Student Disability Services Survey