EVERGLADES UNIVERSITY
Disability Registration Agreement

Student Number:  _______________________________________________	

Student Name (Print):   	

A.	I understand that I am registering for services from Everglades University and that I may be eligible for services such as information, referral, reasonable adjustments/accommodations and/or other individualized services that may be needed for access to courses, programs or facilities. If Everglades University is unable to provide the necessary services, I will be referred to other appropriate community agencies.

Everglades University Adjustment/Accommodations Disclaimer

I am aware that:
o	The types of adjustments/accommodations provided to students with disabilities will vary depending on the nature of the disability and the course content.
o	It is not unusual for there to be an initial trial and error period of finding the best way to accommodate the student.
o	The University is committed to assisting students and faculty in finding reasonable alternative accommodations that are effective.
o	The overall goal is to promote student independence and success within the context of a competitive academic environment.
o	The student is asked to be a responsible and active participant in this process by advising the Campus Vice President if he/she encounters any problems.
o	The granting of accommodations by the University Accommodations Review Committee in no way guarantees that accommodations or equipment will be granted by outside entities (such as non-contracted testing boards, employers, other learning institutions).
o	Reasonable accommodation/adjustment will be made with outside entities contracted by Everglades University (such as contracted testing sites, rotation sites, and work study sites).

Student Initial: ___________

B.	I understand that the University needs disability information to provide services and to conduct reporting and research functions.  This data is classified by disability.

C.	I understand that as a student, I am responsible for reviewing the rights and responsibilities pertaining to disability access.

D.	I understand that I will not be eligible for services if I do not provide documentation of a diagnosed disability, do not have a diagnosed disability or do not follow Everglades University policies and procedures.

E.	I understand that if I request Everglades University to facilitate adjustments/ accommodations on my behalf, the University may need to consult with other University personnel. I give my permission to have disability related information shared with appropriate University personnel (i.e., Office of Student Financial Aid, Academic Affairs, and/or appropriate faculty) to facilitate such requests.

F.	I understand that I must meet with the Dean and the Instructor of record prior to each term to ensure that adjustments/accommodations are provided.

G.	My disability may be disclosed as:

Student Signature:  	__________________	Date: __________________

Campus Vice President:	Date: